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Podcasts

- Hazards of the Job
  April 20, 2019Podcasts / Words of JenPhoto by Kelly Sikkema on Unsplash I wrote this piece on July 11, 2009, on a website for one of my podcasts (that no longer exists). I wrote it while I was sick and fighting a hazard of the job that teachers have to put up with – constant exposure to germs and viruses! This piece has been edited for typos and clarity. I read “Hazards of the Job” on Episode 047 of Words of Jen. I’m writing this while running a fever. It is not too high of a fever, so don’t panic. These are not my “last words” in blog format. No, I just have a fever, probably due to the start of a cold that will become a raging sinus infection when it grows up. The reason I am sick is because I work with children. An occupational hazard of teaching is that you catch absolutely everything! Every cold, flu, virus, germ, parasite…. every last damed one of them! I just started teaching again about six months ago. I love what I do and have wonderful coworkers. The students are fascinating, each in their own way. I truly feel like I have found where I am supposed to be right now. The only thing I would change, if I could, is the level of sickness I am constantly exposed to. Kids sneeze into the air, showering everything in their path with microscopic, virus-laden droplets. Younger kids simply do not understand the reason why we ask them to use a Kleenex (instead of a sleeve) to wipe their nose. They don’t get why we try to discourage them from picking their noses, or why we insist they must wash their hands – with soap – after using the bathroom. Inevitably, children will wait until there are no adults paying attention and “forget” to do all the things we ask them to do in order to avoid spreading disease. They end up sharing whatever communicable diseases they have with everyone else. All it takes if for one kid to get sent to school with a cold, and I’m doomed. Germs spread like sand at the beach. You cannot help but have a few grains attached to you that you didn’t even see – no mater how careful you are. I have been severely sick three times in the six months since I’ve gone back to teaching. Twice is from what I call the “Curse of the New Building”. Ever wonder how many strains of the “common cold” exist? Count up all the school buildings. I am convinced that there is a unique strain in each and every one of them. Three weeks into the new teaching job, I got a nasty sinus infection. It was as though the unique mix of germs and viruses that called this particular school building home knew that I was easy prey. Unlike the teachers who had been there longer than me, I had not been there long enough to build up immunity to this invisible illness-causing cocktail. It is no fun to be on antibiotics for a week at a new place of employment. The students I worked with were in a special education classroom because they had a history of becoming violent, throwing chairs, or “eloping”. In this context, “eloping” means that the student starts running like a gazelle in a fit of rage, tears, emotional instability, or PTSD. They run towards wherever it is they are driven to run to. Teachers are required to quickly follow after an “eloping” student in a desperate attempt to keep them safe. Antibiotics tend to do unpleasant things to people’s stomachs. Mine did not thank me for making my body do a sudden sprint across campus. This is the type of teaching assignment that drains a teacher’s physical, mental, and emotional energy on a daily basis. High stress environments aren’t a good place to be while trying to fight off an infection. Things got less fun when the first round of antibiotics failed to do its job. There is one that I use all the time, and it always brings me right back to health. Unfortunately, the antibiotic did absolutely nothing for me this time. I spent another week on a second round of antibiotics. Finally, after I had taken them all, it felt like the sinus infection was gone. I started feeling a little better. That was when the resident flu strain found me. Unfortunately, I happened to start teaching at this school right when the United States was coping the pandemic called “Swine Flu” (which is also called H1N1). I’ve had the flu before, but this time I felt much worse than usual. I ended up going to a MedStop for diagnosis and treatment. They made me wear a mask in the waiting room. No one wanted to sit next to me, for fear of catching Swine Flu. The doctor required a sample of mucus from my nose, and offered me the choice of two equally unpleasant ways for him to obtain it. I’ll spare you the details. Clinics were required to test every patient who had so much as a bad cold for H1N1 – just in case. It turned out that I did not have Swine Flu. Instead, a slightly less vicious flu virus was attacking me. The doctor required me to stay home for an entire week. My coworkers understood, and were likely relieved that I wasn’t coming to school to spread this bad flu bug around. My principal was… less understanding. The unnamed flu that I acquired made me much more exhausted than normal. I spent my required time off resting, napping, and drinking plenty of liquids. When I was awake, I alternated between worrying about if I was going to get fired for being absent, and fearing what this strain of flu would mutate into come next Fall. Hazards of the Job 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!...
- Jen’s Lore Corner – Kala – Episode 012
  March 31, 2019Jen's Lore Corner / PodcastsWelcome to Jen’s Lore Corner, a podcast about the lore of the Diablo video game series. This podcast started as a segment on the Shattered Soulstone podcast. I decided to re-release those segments in their own podcast. New content started with Episode 010. In this episode, I talk about Kala, a noblewoman who is forced to create a new life for herself. Players can find her in Act II in The Hidden Camp. Before I started recording this episode, I put together a blog post about Kala and her story. She is a character that starts out terrified, and grows into a confident woman who is ready to travel Sanctuary and write poetry. If you enjoyed this blog post please consider supporting me on PayPal.me. Thank you! Jen’s Lore Corner – Kala – Episode 012 is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. https://media.blubrry.com/bookofjen/p/content.blubrry.com/bookofjen/JLC012.mp3Podcast: Play in new window | DownloadSubscribe: Android | RSS...

Diablo III

- Season 16 (Season of Grandeur) – Slayer
  March 24, 2019Diablo III / Diablo SeasonsMy main goal for Season 16 was to complete the Season Journey up through Chapter IV and get the Wings of Lempo. What’s next? My second goal is to finish enough of the Season Journey to unlock more non-Seasonal stash space. The first step towards that goal is to complete Slayer. I had already finished two objectives before I unlocked Slayer. Rifticulous: Finish a level 70 Nephalem Rift on Torment V difficulty or higher. No, You Can’t Have It Back: Obtain a Legendary item by spending Blood Shards with Kadala. One of the Slayer objectives requires the player to complete a Greater Rift 30 solo. Since I had to do this one by myself, I decided to stream it. Here’s what I got done in the video above: Completed a Torment I Nephalem RiftStruggled through a Greater Rift Level 22. It was worth the effort. Crawling Through the Riftage High Plaines Rifter Gemming Up The Works I completed Greater Rift Level 22 at 6:55.232. Ran another Torment I Nephalem RiftCompleted a Greater Rift Level 24 I completed Greater Rift Level 24 at 6:00.933. Raised the difficulty to Torment IIRan a Torment II Nephalem RiftTried a Greater Rift Level 27, failed badly, and opted outRaised the difficulty to Torment IIIRan a Torment III Nephalem RiftCompleted a Greater Rift Level 25 Fighting The Rift Tide Feeling So Low This time, I died shortly after killing the Rift Boss. There is definitely an advantage to playing softcore instead of hardcore. If my Witch Doctor was a hardcore Seasonal character – I’d have to start all over again. I completed Greater Rift Level 25 at 7:28.516. Completed a Greater Rift Level 27 I completed Greater Rift Level 27 at 11:50.633. As you can see in the video above, I really struggled with Greater Rift Level 27. I died a lot, but managed to launch the Rift Boss. That’s when things got worse. My armor “paper doll” appeared and was bright yellow – indicating I needed to get it repaired soon. The boss killed me over and over and over again, and I ended up completely frustrated by the experience. I ended up with 166 Paragon Points After that, I took a break from Diablo III for a while because I had some dental work done that made me exhausted (more than usual). Sometimes, all it takes is one tiring thing to mess up all my chronic illnesses. A friend suggested that I take a look at an Arachyr Fire-Bats Solo build that was created by Big Daddy Den. The “free set” for Witch Doctors in Season 16 was the Arachyr’s set – so I already had several of the pieces I would need in order to play that build. I continued to work my way through the Slayer objectives. Third Power Cubed: Equip Kanai’s Cube with armor, weapon, and a ring Legendary power. Fire Bad: Kill the Butcher at level 70 without being burned by floor tiles or being grabbed by Ancient Spear on Torment I difficulty or higher. Butchering The Butcher: Kill the Butcher at level 70 on Torment I difficulty or higher. The Realm of Putridness: Slay The Vile Executioner and The Foul Desecrator at level 70 on Torment I difficulty or higher. The Infernal Machine for the Realm of Putridness drops from Sokahr the Keywarden of Putridness in the Dahlgur Oasis. The Realm of Regret: Slay the King of the Dead and The Merciless Witch at level 70 on Torment I difficulty or higher. The Infernal Machine for the Realm of Regret drops from Odeg the Keywarden of Regret in the Fields of Misery. At this point, I had made some gear changes and earned more Paragon Points. It was time to make a second attempt at Greater Rift Level 27. This time I completed Greater Rift Level 27 at 5:50.416. Big improvement! Scar Tissue: Kill the Butcher at level 70 on Torment VII difficulty or higher. Cry Me A River: Kill Maghda at level 70 on Torment VII difficulty or higher. When I was done playing for the night, I had 181 Paragon Points and was most of the way through the Slayer objectives. Here’s what I got done in the video above: Completed a Greater Rift Level 28 I completed Greater Rift Level 28 at 9:56.050. Completed a Greater Rift Level 29 Stonesmith: Level three Legendary Gems to level 5. I completed Greater Rift Level 29 at 6:39.966. I completed a Greater Rift Level 30! Rifted Off: Reach Greater Rift Level 30 Solo with the full bonuses of one of the following Class sets. Solipsist: Reach Greater Rift Level 30 Solo. I completed Greater Rift Level 30 at 8:11.800. Completed a Greater Rift Level 26 to level up a Legendary GemCompleted another Greater Rift Level 26 to level up a Legendary GemRan a Torment VII Nephalem Rift to get more Greater Rift KeysRan a Greater Rift Level 27 to level up a Legendary GemWhen I finished playing, I had 195 Paragon Points I made a short video that shows how to find the Tome of Set Dungeons. The Spirit of Arachyr Set Dungeon is located in a teeny tiny dead end in the Dahlgur Oasis. I had a hard time finding it. After killing everything in the zone, I accepted help from King Tut (who is part of the Shattered Soulstone clan). Shortly after that, I accidentally stumbled upon the Arachyrs Set Dungeon. I feel like I nearly fell right into it (but I don’t think that’s actually possible.) Had I known things would work out this way – I would have accepted help a lot sooner. It took several attempts before I was able to complete the Basic Tier of the Spirit of Arachyr Set Dungeon. There is definitely a learning curve for this one. Incy Wincy Spider: Complete 1 Primary Objective and kill the initial amount of enemies in the Spirit of Arachyr Set Dungeon. Players who complete the Basic Tier of the Spirit of Arachyr Set Dungeon receive a Banner Sigil reward. I had now completed the Set Me Free objective in the Slayer part of the Season Journey. In the video above, I ran some Greater Rifts so I could level up some Legendary Gems. It was the last thing I needed to do to complete the Slayer part of the Season Journey. Gems In, Gems Out: Level one Legendary Gem to level 25. I completed the Slayer part of the Season Journey! Players who completed Slayer in Season 16 received a special portrait frame. It is called “Call To Adventure – Slayer”. This brought me through the end of Slayer. There are more parts of the Season Journey to finish. As you can see in the video above, I started working on the next part right away. Season 16 (Season of Grandeur) – Slayer 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!...
- The Lore of King Kanai
  February 23, 2019Diablo III / Diablo LoreKing Kanai is an NPC (non-player character) in Diablo III. If you have ever taken one of your characters to obtain Kanai’s Cube, you have seen Kanai’s ghost appear and point at the Cube. But, who was King Kanai? There’s plenty of lore about him in the Diablo III game, and some additional information about the inspiration for the character that is presented outside of the game. Sescheron was seen by the Barbarians as more than just a city. To them, it was a living symbol of united Barbarian tribes. Its gates guarded the only path to Sanctuary’s most precious treasure, the Worldstone. The Barbarians, who called themselves the Children of Bul-Kathos, were to defend the gates. Generations of Barbarians guarded and defended the gates. They believed the gates of Secheron would never fall. The Ruins of Sescheron were added to Diablo III in July of 2015. There was a time when Sescheron was a Barbarian bustling city. By the time the player character can access it, the city lies in ruins. What happened to this great city? Baal, the Lord of Destruction, sent an army of the Burning Hells to attack Sescheron. Baal is one of the three Prime Evils (the other two are Mephisto and Diablo). As such, Baal likely had a very large army of demons to unleash upon the Barbarian city. He instructed them to tear the city apart. The Ruins of Sescheron can be found by opening the Act III Adventure Mode map. Players should talk to Zoltun Kulle first. He is conveniently waiting in town for the player to do his bidding. Zoltun Kulle: Yes, I live one more. I’m very hard to kill and really, you did a sloppy job. But, enough small talk. I need your help. When Kanai’s Cube was first added to the game, many players had already killed Zoltun Kulle at least once. Those who played through story mode killed him in order to progress through more of the story. Those who played through Adventure mode during a Season probably killed Zoltun Kulle in a Bounty. Zoltun Kulle: An artifact lies on the ruins of Sescheron, guarded by the spirit of a might warrior who will only grant it to the “worthy”. Zoltun Kulle: I think you’ll have a better chance of impressing this spirit than I. Aid me in this, and I’ll use the artifact to help you. Zoltun Kulle has two journals that tell the player a little bit about the history of Kanai’s Cube. Zoltun Kulle: The Cube was used by my Horadrim brothers in many of their most complex rituals. When its potential became clear, they began to fear its power, the fools. They hid it away, even from me, and created a less powerful implement, the Horadric Cube, which they used for many years. Zoltun Kulle: I never stopped looking for Kanai’s Cube. Finally, I learned that they had entrusted it to a secret society of barbarians. The last of these, Kanai, died in Baal’s invasion of Sesecheron. His spirit guards it still, and he is unlikely to give it to me. But I know someone who can impress even the mighty Kanai. The Ruins of Sescheron can be found in Act III. The player learns more about what happened when Baal’s army invaded Sescheron through some journals that are found in Barbarian’s packs that are scattered throughout the ruins. The journals were written by a NPC Barbarian named Skular. The player will eventually find Skular in a cage. Free him, and he will accompany you as you find and free three other Barbarians. Skular: Baal has invaded Sescheron, but we will fight until we are no more. For we are all that stands between him and our sacred Mountain – and I swear by the blood of Bul-Kathos, hell will pay dearly for each of our deaths. Skular: Chief Elder Kanai was the best of us. He could have been the next Immortal King. None of use have come close to bringing the tribes together since Worusk, but Kanai could have been the one to change that with is indomitable spirit. Though as strong as three warriors, his true strength lay in his compassion. Skular: We showed Baal and his army what it meant to fight true warriors, but when Kanai was killed, it froze the spirits of our bloodied ranks. That was when the battle was lost, for he was truly our king. Skular: Dren, the last of our seers, prophesied the darkness would soon pass. He was wrong. Mount Arreat exploded, and took our souls with it. Many of our dwindling number were lost that day to madness and worse. They are the Unclean. Skular: The years wear on us all. Only a few still live, but we have made a good account of ourselves, killing all but the most vicious of the flesh eaters. To think they were once our kin…as long as even one of them still lives we are all shamed. Put this all together, and you have a short story of the downfall of the Children of Bul-Kathos. Their people were once united, under a previous king named Worusk. But, after that, the various tribes became divided. Chief Elder Kanai worked on reuniting the Barbarian tribes. He was making good progress. Some believed Kanai would become the next Immortal King. He was well respected, as strong as three warriors, and very compassionate. Chief Elder Kanai was a good leader, and was considered to be the true King of the Children of Bul-Kathos. King Kanai was killed in battle when Baal’s army invaded. The result was devastation not only of Sescheron, but also of the Barbarian people. They lost a beloved leader, along with many of their warriors. Even worse, they failed to protect the Worldstone. Generations of Barbarians believed that protecting the Worldstone was their sacred duty. Those who lived through the battle with Baal’s army were undoubtedly dealing with a lot of mental anguish over what happened. A seer predicted that this dark time was going to change. Perhaps this helped some Barbarians to feel a bit hopeful. That hope died when Mount Arreat exploded. Diablo Wiki has information about Mount Arreat. The part that is most relevant here is this: …The Barbarian held that they were all tasked with defending Mount Arreat until death, at which point they were free to pass on. However, some bound their spirits to the mountain, so they could serve the mountain well after their physical forms had perished. The Barbarians buried their warriors upon the slopes of Arreat, and believed that those who were denied this would be doomed to have their spirits roam the land for eternity. When Skular wrote that Mount Arreat exploded “and took our souls with it”, he literally meant the souls of the Barbarians who had been buried there. Baal’s army killed their beloved King, many of their people, and prevented the dead from being free to pass on. They could not rest, and had to wander the land forever. The Ruins of Sescheron are a vivid symbol of the devastation that the Barbarians felt after experiencing so much tragedy. Skular accompanies the player to the Elder Sanctum. He sticks around long enough for the player to find Kanai’s Cube. If you know the lore of King Kanai, seeing his ghost point you to the Cube feels very significant. Skular also goes with the player to The Immortal Throne. He tells the player: There was talk of Elder Kanai being the next Immortal King. He was revered by barbarians everywhere, as you well know. I’m not sure if Skular says that exact sentence to every player class, or if this is reserved for those who are playing a Barbarian. It is possible that Skular figures you read all the journals he left laying around, and learned about King Kanai that way. The path to the throne is lined with the ghosts of the Children of Bul-Kathos. They cannot pass on, so some decided to spend eternity honoring their beloved King Kanai. The body of King Kanai is seated on the throne. He is wearing the armor he wore when he died, and his weapon is next to him. Skular: We put Kanai on the throne after he died as a tribute to his greatness. Skular: I wonder what would have happened if he had lived? Bah, there is no point. King Kanai is not just a legend within the lore of Diablo. He is also a tribute to a real person named Kevin Kanai Griffith. On July 28, 2015, a post about Kanai’s Cube was posted on the Diablo website. From the post (which was written by Nevalistis): …Kevin Kanai Griffith was a beloved member of the Blizzard family and a longtime Diablo fan. He joined Blizzard as an artist on the World of Warcraft team in 2005 and his work can be seen in the Burning Crusade, Wrath of the Lich King, and Mist of Pandaria expansions, as well as the World of Warcraft trading card game. As the Diablo III team came together, Kevin joined and made his mark on the original game, creating a plethora of diverse and moody environments that you’re certain to recognize.Kevin continued producing gorgeous environments and Diablo holiday art throughout the launch and beyond the release of Reaper of Souls……Tragedy struck in February of 2012 when Kevin was diagnosed with a very rare form of cancer known as Alveolar Soft Part Sarcoma (ASPS). Kevin kept his spirits high throughout the grueling treatment process and continued to work on Diablo III as much as he was able, pioneering environmental features such as the weather and night/day cycles experienced in Adventure Mode. Though he fought valiantly, we lost our coworker and dear friend on October 17, 2014. His spirit and legacy will always live on in the many games he’s touched, with his stunning art, as well as the hearts of every individual who had the honor of knowing him…. Every March, there is a special event in Diablo III called Udder Cowlamity. It is a homage to Kevin Kanai Griffith. The event happens in March because that is the month Kevin was born in. To start the event, players must be in Adventure Mode. Go to the Immortal throne and head towards King Kanai’s body. He will awaken. His spirit will leave his body and open a red portal to Kanai’s Stomping Grounds. King Kanai silently invites the player to join him. The goal is to kill every single Infernal Bovine on the map. King Kanai fights along with the player. The Lore of King Kanai 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!...

Book Reviews

- Spook – by Mary Roach
  December 26, 2018Book Reviews / non fictionMary Roach is the author of Stiff – the Curious Lives of Human Cadavers. After writing about what happens to the human body after the person dies, it seems appropriate to write a book about what happens to the human soul after the body dies. Spook – Science Tackles the Afterlife was written in 2005. In my opinion, the best way to read Spook is to set aside whatever religious ideas you may have about the afterlife. Go into this book with an open mind and you will definitely learn something about human nature. This is not the book for people who have strong religious beliefs about the afterlife and who are looking for something that confirms what their religion tells them. It is the book for people who wonder what science can tell us about the soul, where it lives, and where it might go. In Spook, Mary Roach asks plenty of interesting questions, and follows up by finding out what science had to say regarding the afterlife. She does not provide the reader with a definitive answer about what, exactly, one should expect from the afterlife. Readers are free to take in whatever they find to be thought-provoking. The very first chapter delves into reincarnation. Mary Roach traveled through India with Dr. Kurti S, Rawat, director of the International Centre for Survival. He seeks out children who claim to have been reincarnated and gathers up as much information as he can from the child and the child’s family. Mary Roach appears to have experienced culture shock while in India, and I found her observations to be fascinating. There are parts of India where people believe in reincarnation. As such, when a very young child starts talking about people that the child’s parents do not know – the assumption is that reincarnation has occurred. The parents will ask the child questions, in an effort to learn more about who they were in a past life. In the United States, claims of reincarnation are very rare. The process Dr. Rawat uses goes like this: he learns of a child who claims to have been reincarnated. He travels to where that child lives and interviews the child and their family members. Dr. Rawat writes down all the details and studies it later. The best data comes from parents who immediately started writing down what the child told them about his or her former self, the names of that person’s loved ones, and the manner in which the person died. For some reason, people who have been reincarnated tend to have died a quick, unexpected, and very violent death. In short, the best outcome is when the child’s family, and the living relatives of the person who has been reincarnated into the child, meet and become like extended family. The worst outcome is when a scammer picks a target (usually someone rich), learns about their deceased relative, and coaches the child to pretend to be that person. Part of Spook includes details about a variety of ideas regarding where in the human body the soul “lives”. The specific part of the body that was believed to house the soul changed over time. Potential parts have included: sperm, ova, the pineal gland, the nerves (and/or the nervous system), a bone on the end of the spine called the luz, the coccyx, and one of the four chambers of the brain. A controversial study (which had many ethical issues) was done in an effort to find out how much the soul weighs. It was done in 1854 at a Consumptives Home, a charity that cared for people who were slowly dying of tuberculosis. A surgeon and physician named Duncan Macdougall placed a bed on a large, industrial, scale. A person who appeared to be about to die of consumption was placed on the bed. Macdougall, and other doctors, watched and waited for the person to die. At that moment, they checked the scale to see if the total weight had changed. The scale often showed that the person (and the bed they were lying on) weighed a tiny bit less immediately after the person died. The study was controversial for many reasons, the biggest of which was the question of whether a person who was about to die of consumption could truly give consent to being in the study. Despite this, other doctors attempted to replicate the study (using animals instead of people). The animals were not dying of consumption. They were euthanized after being placed on the industrial scale. The results of these studies contradicted each other and were inconclusive. From here, things move away from the realm of science (wonky and questionable as it was) and into the realm of seances (which were run by women who intended to scam people). I found this part of the book to be extremely entertaining, and I’ll leave you to read it for yourself. In short, seances became a popular thing for people to experience. Many people came to the seance already believing that they would encounter a spirit. They were easy marks. Another interesting thing I learned from Spook is that people have been using whatever the most modern technology was at the time to attempt to record the voices of spirits (or ghosts). Some of the earliest recordings were of mediums who claimed to be channeling a spirit – who had a lot of things to say. Sometimes, people heard crackles over the radio and interpreted them to be voices from the beyond. It often turned out to be the person’s imagination – with the exception of a situation where the people lived really close to where the radio waves were being transmitted. Those people were actually hearing radio transmissions from local stations that were somehow picked up by things like – for example – their oven. More recently, people began using tape recorders to capture the voices of the spirits. I presume people have started using there smartphones for this purpose. The common theme here is that people have a tendency to want to believe that the newest, hottest, piece of technology that can record something is definitely going to pick up the voices of spirits. Spook is a truly bizarre book that mixes scientific study (such as it was) with religion and the cultural beliefs of a population in a specific location at different points in history. When it comes to the afterlife, these concepts blend together and influence not only what a person believes about the human soul, but also what the afterlife is like. Spook – by Mary Roach 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!...
- Stiff – by Mary Roach
  December 19, 2018Book Reviews / non fictionStiff – The Curious Lives of Human Cadavers is an exploration of what happens to the human body after the person dies. It is not a book for people who are squeamish, or who are mourning a loved one. I would definitely recommend Stiff to writers of mystery or crime novels, who need a good source of information about the timeline in which a cadaver decays. There are some things that people probably shouldn’t Google. Mary Roach does an excellent job of presenting factual information about a difficult topic to consider, while injecting just the right amount of what might be considered gallows humor. She does this without ever disrespecting the deceased. Stiff was published in 2003, so it is possible that some of the information in the book might be outdated. I suspect that the majority of it is still valid (but did not take the time to look up things to see what may have changed.) There’s a chance that the medical stuff could have been updated with new techniques between when the book was written and today. The first chapter of the book is about Mary Roach’s observations as she watches a group of doctors who are practicing face lifting techniques on cadaver heads. Some of the doctors are respectful of the person whose donated head they are working on. Others are less so. Mary Roach wonders who has the job of removing the cadaver heads from the rest of the cadaver – and she finds the answer to that question. Another chapter goes into the history of body snatchers. For a long time, it was illegal to dissect a dead human body. Anatomists had to resort to not-quite-legal means of obtaining bodies from which to learn about human anatomy. In some cases, the bodies were supplied by “resurrection men” who unearthed the recently deceased, put the body into a sack, and discretely delivered it to the doctor. It was apparently a good way to earn some money. It is also the reason that religious people – who believed the body needed to be entirely intact in order for the person to get into heaven – invested in Mortsafes. In that same chapter, there is an interesting (and disturbing) story about William Burke and William Hare, two “resurrectionists” who got into trouble. A man died in Hare’s boarding house before paying his fare. Hare and Burke took the body to an anatomist. After learning that bringing dead bodies to anatomists resulted in a nice payment, Hare and Burke started murdering people (and bringing the very recently dead to the anatomists). I’ll leave you to read the chapter to see how this obviously illegal situation was resolved. There is a chapter about the University of Tennessee’s Anthropological Research Facility – which is a large area of land in which cadavers are placed for the purpose of allowing researchers to study the timeline of decay. Part of the purpose is to assist those who investigate crime scenes. Other chapters cover a wide range of subjects, including information on whether or not cadavers are used for automobile crash tests. There is a chapter about the ethical issues involved in using cadavers (or cadaver legs) to determine which shoes provide the best protection for a living person who has stepped on a land mine. One of the chapters that I found especially interesting involved extremely religious Christians, who were alive, and who volunteered to be “crucified”. They weren’t actually nailed to a cross. It was a safely done approximation of crucifixion that involved people being secured to a huge cross by leather straps. The purpose of the experiment was to debunk previous hypotheses about what Jesus may have experienced. The purpose was to determine whether or not the volunteers had difficulty breathing while on the cross, and to figure out where the nails would have to be placed in order to prevent them from ripping out. Other oddities found in Stiff include details about an incredibly disturbing experiment where a researcher removed the head of an anesthetized monkey and attached it to the body of an entirely different monkey. There is also an amusing story in which Mary Roach goes to China in an effort to confirm, or debunk, an urban legend about human cadaver parts being used in the dumplings served in a restaurant. I found Stiff to be interesting, and strange, and filled with historical context that I might not have learned about if I had not read this book. There is definitely a tendency for people who work with cadavers (or parts of human bodies) to think of the cadaver as a person – and not a person – at the same time. Medical students, who must take a course that involves dissection of human cadavers, end up with a mix of emotions. They must, at times, distance themselves from considering the cadaver as a person. At the same time, many students form emotional attachments to the cadaver. This results in the university holding a mass funeral for the cadavers at the end of the semester. Students eulogize about the cadaver they worked on. It is a way of letting go, and thanking the person who donated their body to science, at the same time. Stiff – by Mary Roach 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

- Riglee Finishes Hallow’s Eve
  November 21, 2018Holiday Events / World of WarcraftHallow’s End is my favorite of all the World Events in World of Warcraft. I’ve been slowly working my way through it with my main, Riglee (a Gnome Death Knight). The main problem was that she was always too low a level to even try and earn some of holiday related achievements. This year, Riglee was somewhere around Level 96 or so when Hallow’s End started. I was able to get her through almost all of the Hallow’s End achievements – with one exception. Riglee hit Level 99 near the end of the World Event, and needed to be Level 100 in order to find Scarecrow Pepe in her Garrison. In 2015, which must have been the last time I put effort into Hallow’s Eve, I put together a blog post that showed my progress through it. This year, I ran out of time before I had to leave for BlizzCon (and the event ended before I got back home.) This is not a complaint – I had a wonderful time at BlizzCon 2018. It is simply an observation. Tricks and Treats of the Cataclysm Last year, Riglee visited the Candy Buckets at: Firebeard’s Patrol, Twilight Highlands; Victor’s Point, Twilight Highlands; and Thundarmar, Twilight Highlands. Ramkahen, Uldum; Oasis of Vir’sar, Uldum; Shrine of Aviana, Mount Hyjal; Highbank, Twilight Highlands Deepmist Grotto, Vashj’ir; Deepholm, Temple of the Earth; Tranquil Wash, Vashj’ir; Silver Tide Hollow, Vashj’ir I’m missing a few screenshots of some of the other Candy Bucket locations in the Cataclysm zones. It is possible I was too tired to remember to take those screenshots. Or, they might have gotten lost in the pile of other World of Warcraft screenshots. I will update this blog post if, one day, I find where those screenshots went. I earned the Tricks and Treats of Cataclysm Achievement! Tricks and Treats of Cataclysm: Visit the Candy Buckets in Cataclysm zones. Deepholm, Temple of Earth Mount Hyjal, Grove of Assenia Mount Hyjal, Nordrassil Mount Hyjal, Shrine of Aviana Twilight Highlands, Firebeard’s Patrol Twilight Highlands, Highbank Twilight Highlands, Thundermar Twilight Highlands, Victor’s Point Uldum, Oasis of Vir’sar Uldum, Ramkahan Vashj’ir, Darkbreak Cove Vashjir, Deepmist Grotto Vashj’ir, Silver Tide Hollow Vashj’ir, Tranquil Wash Tricks and Treats of Pandaria Paw’don Village, Jade Forest; Pearlfin Village, Jade Forest; Tian Monastery, Jade Forest; Jade Temple Grounds, Jade Forest; Greenstone Village, Jade Forest; Dawn’s Blossom, Jade Forest Sri-La Village, Jade Forest; Zhu’s Watch, Karasang Wilds; One Keg, Kun-Lai Summit; The Grummie Bazaar, Kun-Lai Summit; Klaaxi-vess, Dread Wastes; Soggy’s Gamble, Dread Wastes Pang’s Stead, Valley of the Four Winds; Stoneplow, Valley of the Four Winds; Tavern in the Mists, The Veiled Stair; Mistfall Village, Vale of the Eternal Blossoms There are more Candy Bucket locations in Pandaria that are required in order to complete Tricks and Treats of Pandaria achievement. I seem to have lost some of my screenshots. This is likely because I was playing while tired. The Candy Bucket at Westwind Rest, in the Kun-Lai Summit, is a difficult one to get to. When my Gnome Death Knight arrived at that town – it was on fire. There were no NPCs there (because they had evacuated). There was no Candy Bucket. After searching around online, I learned that the problem was that this content was “phased”. From what I understand, Westwind Rest stays on fire until the player completes a specific quest chain. Here is how to do it: First, go to Binan Village, in the Kun-Lai Summit. Look for an NPC named Mayor Bramblestaff. He should have a quest for you. I cannot remember if he has this quest right away, or if you have to complete a few other quests first. If he doesn’t have a quest for you, go outside the village and complete the quests from the NPCs out there. Then, go back to Mayor Bramblestaff. Mayor Bramblestaff: It would seem that your Admiral Taylor has awakened from his injuries. He and his people are upstairs in the apothecary’s house across the way. He has requested your presence. Go into the apothecary’s house. Climb up the stairs. Admiral Taylor and a few other Alliance characters are up there. Admiral Taylor is the human who is sitting on the floor. He’s yelling an an Orc (and two Horde characters) who are sitting on the floor across the room. I have no idea what the story-line is here, because I’ve been going through the content randomly. Admiral Taylor: Riglee, is that you? I can’t believe we survived the destruction of the Jade Serpent. Some of us anyway. Admiral Taylor gives you the Westwind Rest quest. It starts with narrative: <Admiral Taylor winces in pain.> Admiral Taylor: Jade Forest was a disaster. Anduin’s gone. We lost some good people. We didn’t stop the Horde from advancing into the continent. But I think I’ve found a way to get the locals on our side. You just helped fight off some of these “yaungol”, no? I hear yaungol sacked Westwind Rest, a local village. We’ve been told that two groups of survivors have camped out along the road west out of town. We help them out, maybe they’ll consider siding with the Alliance. Next, you need to speak with Farmhand Bo and Elder Tsulan in the Yaungol Advance. They are NPCs who are, as Admiral Taylor said, “camped out along the road.” Farmhand Bo: The… the yaungol! They attacked my farm, and the nearby village, Westwind Rest… killed some of us, and the ones they didn’t kill they chased off. I managed to gather some of us here. Any word on help coming from Binan? The player needs to click on the part that says: I’m from the Alliance. We’re here to save you and rebuild your village. Farmhand Bo: I don’t know about this “Alliance”, but you look trustworthy. I’ll gather everyone up and meet you when we’re ready to rebuild! Next, you need to go find Elder Tsulan. He’s standing by the road (in a different spot from where you found Farmhand Bo). A group of Kun-Lai evacuees is there with Elder Tsulan. Elder Tsulan: As dark as things seem, I must not give up hope. We must not be cowed by the violence of the Yaungol. You… have come to help us? The player must click on the part that says: I’m from the Alliance. We’re here to save you and rebuild your village. (I’m assuming that it would swap “Alliance” for “Horde” depending on what faction the player’s character belongs to.) Elder Tsulan: I will not rest until our people are returned and this village rebuilt. Elder Tsulan: Someone has come to save us? Perhaps all is not lost… Elder Tsulan: Well… we are alive, and that is better than we could have hoped for without your help. But, if this is truly to become a base of operations for you, and if we are to join your Alliance, there is one more thing you must do to guarantee our security. Elder Tsulan: The yanguol have always been a difficult proud people, but never this violent or aggressive. I do not know what has prompted this change in their behavior, but we don’t have time to find out, now. We fear for our lives and livelihoods as long as Ur-Bataar, leader of the Batarri yaungol, lives. Go, set the banner in his camp ablaze to challenge him, and then defeat him in battle. Only then will we be secure. Riglee fought Ur-Bataar – Warbringer of the Bataari Ur-Bataar: No! Kun-Lai was ours…. Elder Tsulan: You did it! At the very least, we have justice and safety, though in the process we have lost so much. Regardless, it has been decided. We will join the Alliance, and with your help, rebuild this village. I earned the Westwind Rest Achievement. A cinematic plays. It starts with Westwind Rest very much on fire. Pandarans rush in and start putting out the fires. Admiral Taylor and his team arrive. Westwind Rest has become an Alliance town. It is now possible to loot the Candy Bucket at Westwind Rest. I earned the Tricks and Treats of Pandaria Achievement. Tricks and Treats of Pandaria: Visit the Candy Buckets in Pandaria. Dread Wastes, Klaxxi’vess Dread Wastes, Soggy’s Gamble Jade Forest, Dawn’s Blossom Jade Forest, Greenstone Village Jade Forest, Jade Temple Grounds Jade Forest, Paw’don Village Jade Forest, Pearlfin Village Jade Forest, Sri-La Village Jade Forest, Tian Monastery Krasarang Wilds, Marista Krasarang Wilds, Zhu’s Watch Kun-Lai Summit, Binan Village Kun-Lai Summit, The Grummie Bazaar Kun-Lai Summit, One Keg Kun-Lai Summit, Westwind Rest Kun-Lai Summit, Zouchin Village The Veiled Stair, Tavern in the Mists Townlong Steppes, Longying Outpost Vale of Eternal Blossoms, Mistfall Village Vale of Eternal Blossoms, Shrine of the Seven Stars Valley of the Four Winds, Pang’s Stead Valley of the Four Winds, Stoneplow This Hallow’s Eve was the first time I was able to get one of my characters into the Headless Horseman fight. In previous years, all of them were too low a level to participate. I completed The Headless Horseman Dungeons, and earned an Achievement. Bring Me The Head of… Oh Wait: Kill the Headless Horseman. The Loot Filled Pumpkin that I got after killing The Headless Horseman included one of those awesome flying brooms. Fun! I attempted to complete the G.N.E.R.D. Rage achievement in during previous Hallow’s Eve events, but I guess it wasn’t a priority. This year, I decided it was worth getting into a random battleground where I could do some PVP. With a little effort, I was able to complete the G.N.E.R.D. Rage Achievement. G.N.E.R.D. Rage: Earn 10 honorable kills while under the influence of the G.N.E.R.D. buff. It’s a slap in the face! It turned out that the G.N.E.R.D. Rage Achievement was the last one I needed to complete the Hallow’s End event. The text says Riglee earned the Hallowed Be Thy Name Achievement. Hallowed Be Thy Name: Complete the Hallow’s End achievements listed below. Trick or Treat! Bring Me The Head of… Oh Wait That Sparkling Smile G.N.E.R.D. Rage The Masquerade Tricks and Treats of Azeroth Out With It The Savior of Hallow’s End Rotten Hallow Check Your Head Sinister Calling This Achievement comes with a Title Reward: The Hallowed. It can be used on all of your characters. (Or, maybe it is limited to all your characters from one faction. I’m not sure.) I collected enough Tricky Treats to purchase a Hallow’s Eve Pet. Widget the Departed is a ghost kitty. What’s left for next year’s Hallow’s Eve? I could go visit Candy Buckets and gather up enough Tricky Treats to get another Hallow’s Eve pet. Or, I could try and get one of my alts through the Hallow’s End Achievements. Hopefully, by next Hallow’s Eve, Riglee the Death Knight will be at level 100. There is one more Hallow’s Eve Achievement (but it doesn’t appear to be required in order to finish the event). Characters who are Level 100 (or higher) can go find Scarecrow Pepe in their Garrison. Riglee wasn’t quite at Level 100 yet, so she could not get the quest that players have to complete before they can find Scarecrow Pepe. Riglee Finishes Hallow’s Eve 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: BlizzCon 2018 Virtual Ticket Items
  October 28, 2018World of Warcraft / World of Warcraft otherPeople who purchase the BlizzCon 2018 Virtual Ticket (or who have purchased a ticket to BlizzCon 2018 – the Virtual Ticket access comes with it) will receive a bunch of goodies for Blizzard Entertainment’s games. In this blog post, I focus on the World of Warcraft BlizzCon 2018 items. The Achievement associated with the BlizzCon 2018 items is called Flying Colors. It shows part of the Alliance cape, possibly because I went after the items on my Night Elf Hunter before I grabbed them on my Forsaken Warlock. (This is just a guess.) Flying Colors: Proud owner of the Alliance and Horde War Mantles and War Banners from the 2018 BlizzCon. This is what the Alliance War Mantle looks like. The Stormwind Champion’s War Banner can be found in your Toy Box. This is what the Stormwind Champion’s War Banner looks like. I planted this near the front of Stormwind while working on the Hallow’s End quests. Stormwind was experiencing night at the time, and I figure the Banner would be more shiny during the day. This is what the Horde War Mantle looks like. The Orgrimmar Hero’s War Banner can be found in your Toy Box. Here is what the Orgrimmar Hero’s War Banner looks like in game. I can’t remember where my Forsaken Warlock was when she planted this Banner. I think the skull on it looks very cool! World of Warcraft: BlizzCon 2018 Virtual Ticket Items 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!...

Out of Spoons (Chronic Illness)

- A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three
  March 28, 2019health insurance / Out of SpoonsImage by chayka1270 from Pixabay Before you jump into this blog post, you may want to read Part One and Part Two. In 2018, the Democratic Party became the majority in the U.S. House of Representatives. The 116th Congress started on January 3, 2019. The Democrats set out to stop the GOP from destroying Obamacare, Medicare, Medicaid, and other health care that is affordable for low-income and marginalized people. Unfortunately, the GOP still had the majority in the U.S. Senate, and President Trump, a Republican, was still President of the United States. As such, the shenanigans continued. January 3, 2019: CNBC posted an article titled: “Nancy Pelosi launches House effort to save Obamacare from death in a Texas Court Case”. It was written by Dan Mangan. From the article: The House of Representatives on Friday launched a legal effort to help defend Obamacare in a court case that is threatening to kill that landmark health-care reform law, which has led to the expansion of health insurance to millions of Americans.The House, which as of Thursday is controlled by Democrats and led by Speaker Nancy Pelosi of California, asked a federal judge in Texas to allow it to intervene in the case.If Judge Reed O’Connor grants that request, it would allow the House to make legal arguments in the dispute going forward, up to and including at the U.S. Supreme Court……A lawyer for the House said in a filing in U.S. District Court for the Northern District of Texas that federal legal rules give “the House an unconditional right to intervene” in the case, given that Obamacare was passed into law by Congress, and given that the Trump administration is not defending the law……The House said that its “interest in this action… is not adequately represented by the existing parties.”Pelosi on Friday noted that on Thursday “the new Democratic House took action to protect people with pre-existing conditions and all Americans’ health care” by passing a resolution seeking to intervene in the lawsuit… January 3, 2019: NPR posted an article titled: “How the Federal Shutdown Is Affecting Health Programs”. From the article: There seems to be no end in sight for the current partial government shutdown, the third since the beginning of the Trump administration.For the vast majority of the federal government’s public health efforts, though, it’s business as usual……But seven bills are outstanding – including those that fund the Interior, Agriculture and Justice departments – and that puts the squeeze on some important health-related initiatives……Since HHS funding is set through September, the flagship government health care programs – think Obamacare, Medicare and Medicaid – are insulated……Because Congress has yet to approve funding for the Indian Health Service, which is run by HHS but gets its money through the Department of the Interior, IHS feels the full weight of the shutdown. The only services that can continue are those that meet “immediate needs of the patients, medical staff, and medical facilities”, according to the shutdown contingency plan.That includes IHS-run clinics, which provide direct health care to tribes around the country. These facilities are open, and many staffers are reporting to work because they are deemed “expected,” said Jennifer Buschik, an agency spokeswoman. But they will not be paid until Congress and the administration reach a deal.Other IHS programs are taking a more direct hit. For example, the agency has suspended grants that support tribal health programs as well preventive health clinic run by the Office of Urban Indian Health Programs… January 6, 2019: Forbes posted an article titled: “Pelosi Wants More Americans Subsidized To Buy Obamacare”. It was written by Bruce Japsen. From the article: …The New Speaker of the U.S. House of Representatives said this weekend she wants changes in the income threshold to allow more Americans to gain subsidies so they can buy individual coverage known as Obamacare. Helping more people get subsidies are among the “couple of things” she would like to do to improve the ACA and expand health coverage to more Americans, Pelosi, a California Democrat, told MSNBC Friday night.“Raise the income level at which people can get subsidies so more people would be able to get subsidies,” Pelosi told MSNBC’s Joy Reid in an exclusive interview that aired Friday night and this past weekend. “I think that’s very, very important.”By expanding the pool of American who gain subsidies, that’s good news for insurers Centene, Molina Healthcare, Oscar Health, Bright Health, Cigna, Anthem, and other Blue Cross and Blue Shield plans that have remained in the business of selling ACA-compliant individual coverage……Exactly what the income threshold would be raised to is unclear. Pelosi didn’t disclose further details in her MSNBC interview. Hearings, though, are expected on the ACA in several Congressional committees. The filing mentioned in the article is posted on the Speaker of the House website. January 8, 2019: Peter V. Lee, Executive Director of Covered California Board of Directors, sent a letter to Seema Verma, Administrator for the Center for Medicare and Medicaid Services. From the letter: Covered California submits these comments in response to the proposed Program Integrity regulations CMS-9922-P, specifically, on the unnecessary proposal to require separate billing for non-Hyde abortion services. We provide the following comments based on our experience and analysis of the necessary efforts to ensure ongoing sustainability for state-based marketplaces and effective services to the consumers we serve. Through our strong relationships with the 11 health insurance companies participating in Covered California, we have created a robust health insurance market that fosters a competitive environment while empowering consumers to choose plans that give them the best value.Covered California believes these proposed regulations are unnecessary, would impose a substantial burden, and will not be beneficial for consumers or the individual market. Current rules and processes ensure that funds are segregated, and no federal funs are used for non-Hyde abortion services. Should Health and Human Services (HHS) not withdraw this proposed rule, Covered California requests that HHS delay the effective date to allow time for affected entities to mitigate consumer confusion and implement the required changes to information technology systems.As proposed, HHS would withdraw its previous guidance, which permits Qualified Health plans (QHP) issuers to satisfy the separate payment requirement in one of several ways, including by sending the enrollee a single monthly bill that separately itemizes the premium amount for non-Hyde abortion services. Currently, HHS also allows consumers to make the payment for non-Hyde abortion services and the payment for all other services in a single transaction. HHS is now promising to require issuers to send – and consumers to pay – two entirely separate bills for the premium attributable to certain (non-Hyde) abortion services and the premium for all other services. Additionally, HHS is proposing that any consumer who failed to pay the full premium in both bills will be terminated for non-payment (subject to state and federal grace periods).If finalized, this regulation will be confusing for consumers and will likely lead to consumers dropping coverage due to inadvertently not paying the full premium. While HHS asserts that consumer confusion can be mitigated by sending bills only through email or other electronic communication, this does not address the underlying confusion that will occur due to two separate bills being sent to a consumer for their QHP. Not only does this practice conflict with widely accepted industry standards, there is no practical way to implement such a policy as a consumer cannot be forced into forgoing mail as their preferred method of communication. In California, we encourage our consumers to opt into email as their preferred communication but even after our encouragement, 70% of enrollees continue to receive communication via standard mail. HHS’s proposal also does not consider the fact that some individuals do not have consistent access to the internet and would be unable to receive or make their monthly premium payment.These proposed regulations will impose millions of dollars of new costs and significant operational burdens on Exchanges and QHP issuers, diverting resources from other important work that Exchanges and carriers perform to provide affordable and reliable health coverage to their consumers. For example, Covered California will need to protect the market from known adverse impacts of this proposed regulation by redirecting vital funds from other programs to consumer outreach and marketing……These regulations will cause significant consumer confusion and impose serious administrative operational burdens on Covered California. If these new, unnecessary and burdensome regulations are implemented, Exchanges could not possibly put them in place in the time proposed. January 9, 2019: The House of Representatives voted on a H.Res. 6 – Adopting the Rules of the House of Representatives for the One Hundred Sixteenth Congress, and other purposes. Here is the key part of it: TITLE III – INTERVENTION IN LITIGATION INVOLVING PATIENT PROTECTION AND AFFORDABLE CARE ACTSEC. 301. FINDINGS.The House of Representatives finds the following:(1) Texas, Wisconsin, Alabama, Arkansas, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Governor Paul LePage of Maine, Mississippi (by and through Governor Phil Bryant), Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Utah, and West Virginia have filed suit in the United States District Court for the Northern District of Texas, arguing that the Patient Protection and Affordable Care Act… is unconstitutional and should be enjoined by asserting that the Act’s requirement to maintain minimum essential coverage (commonly known as the “individual responsibility provision”) in section 5000A(a) of the Internal Revenue Code of 1986, is unconstitutional following the amendment of that provision by the Act to provide for reconciliation pursuant to titles II and V of the concurrent resolution on the budget fiscal year in 2019… (commonly known as the “Tax Cuts and Jobs Act”).(2) These State and individual plaintiffs also seek to strike down the entire Patient Protection and Affordable Care Act as not severable from the individual responsibility provision.(3) On June 7, 2018, the Department of Justice refused to defend the constitutionality of the amended individual provision, despite the well-established duty of the Department to defend Federal statutes where reasonable arguments can be made in their defense……SEC. 302 AUTHORIZING LEGAL ACTION BY HOUSE.(a) AUTHORIZATION – The Speaker, on behalf of the House of Representatives, is authorized to intervene, otherwise appear, or take any steps in the case of Texas v. United States … and in any appellate proceedings arising from such case. The Speaker, in consultation with the Bipartisan Legal Advisory Group, is also authorized to intervene, otherwise appear, or take any other steps in any other cases involving the Patient Protection and Affordable Care Act to protect the institutional interests of the House and to defend such Act, the amendments made by such Act to other provisions of law, and any amendments to such provisions, including the provisions ensuring affordable health coverage for those with preexisting conditions.(b) ROLE OF GENERAL COUNSEL. – The Office of General Counsel of the House of Representatives, at the direction of the Speaker, shall represent the House in any litigation pursuant to this title. The Office of General Counsel may employ the services of outside counsel, including pro bono counsel, or other experts for this purpose.(c) REPORTS ON AMOUNTS EXPENDED. – The chair of the Committee on House Administration shall cause to be printed in the Congressional Record a statement setting forth the aggregate amounts expended by the Office of General Counsel on outside counsel and other experts pursuant to this title on a quarterly basis, and such statement shall be submitted for printing not more than 30 days after the expiration of each such quarter… January 9, 2019: The House of Representatives voted on H.Res. 6 – Adopting the Rules of the House of Representatives for the One Hundred Sixteenth Congress, and other purposes. The vote was 235 YEAS to 192 NAYS, which means it passed. Almost all of the Democrats voted YEA. Two Democrats did not vote: Lois Frankel (D-Florida) and Stephen Lynch (D-Massachusetts). Three Republicans voted YEA: Brian Fitzpatrick (R-Pennsylvania), John Katko (R-New York), and Tom Reed (R-New York). Almost all of the Republicans voted NAY. Four Republicans did not vote: Ken Buck (R-Colorado), Michael Guest (R-Mississippi), Walter Jones (R-North Carolina) and Brian Mast (R-Florida). January 9, 2019: The Hill posted an article titled: “Dems hit GOP on health care with additional ObamaCare lawsuit vote”. From the article: The House on Wednesday passed a resolution backing the chamber’s recent move to defend ObamaCare against a lawsuit filed by the GOP states, giving Democrats another opportunity to hit Republicans on health care.GOP Reps. Brian Fitzpatrick (Pa.), John Katko (N.Y.), and Tom Reed (N.Y.), joined with 232 Democrats to support the measure, part of Democrats’ strategy of keeping the focus on the health care law heading into 2020. The final vote tally was 235-192.A federal judge in Texas last month ruled in favor of the GOP-led lawsuit, saying ObamaCare as a whole is invalid. The ruling, however, will not take effect while it is appealed.Democrats framed Wednesday’s vote as proof that Republicans don’t want to safeguard protections for people with pre-existing conditions – one of the law’s most popular provisions… January 9, 2019: Speaker of the House Nancy Pelosi posted a statement on her official website. The statement was titled: “Pelosi Statement on House Republicans’ Vote Against Families’ Health Care”. From the statement: Speaker Nancy Pelosi issued this statement after 192 House Republicans voted against a resolution affirming the House’s authority to intervene in the Texas v. United States lawsuit to defend the Affordable Care Act and protect people with pre-existing conditions:“The health and well-being of children and families across America hang in the balance because of Republicans’ monstrous legal assault on health care. But tonight, 192 House Republicans voted to be full accomplices in the GOP’s effort to destroy protections for people with pre-existing conditions and threaten Americans’ health care.“In November, the American people spoke loud and clear: the GOP’s war on health care must end, now. Republicans need to listen to their constituents, and finally work with Democrats to protect the health of families across America. This New Democratic House of Representatives will be relentless in defending protections for people with pre-existing conditions and affordable health care.” January 13, 2019: The Hill posted an article titled: “Judge blocks Trump contraception rule in 13 states”. From the article: A federal judge on Sunday blocked Trump administration rules that would allow most businesses to opt out of covering contraception for their employees if they have moral or religious objections.Judge Haywood Gilliam blocked the rules, which were set to go into effect on Monday, in California, Washington D.C., and 12 other states. Gilliam granted a request for a preliminary injunction from those states, but limited the ban’s scope to only the case’s plaintiffs.California Attorney General Xavier Becerra (D) at the end of December asked Gilliam to block the rules, which would allow more exemptions to ObamaCare’s contraception mandate.Attorneys general in Connecticut, Delaware, Hawaii, Illinois, Maryland, Minnesota, New York, North Carolina, Rhode Island, Vermont, Virginia, Washington state and the District of Columbia joined Becerra’s request for an injunction… January 13, 2019: NBC News posted an article titled: “Judge blocks Trump birth control rules in 13 states and D.C.”. It was written by Alex Johnson. From the article: A federal judge on Sunday temporarily blocked Trump administration rules allowing employers to refuse to provide free birth control from taking effect Monday in 13 states.The regulations, which the Trump administration announced in October 2017, widened the pool of employers that are allowed to claim exemptions from providing contraceptive coverage to include nonprofit groups, for-profit companies, other nongovernmental employers, and schools and universities.Previously, only explicitly religious groups could opt out if they could show “sincerely held” religious objections.In November, the Trump administration issued final rules to enact the broader exemptions beginning Monday. Thirteen states – California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Minnesota, New York, North Carolina, Rhode Island, Vermont, Virginia and Washington state, as well as Washington, D.C., sought the injunction to put the regulations on hold pending the states’ lawsuit opposing them.U.S. Judge Haywood Gilliam’s order – which applies only to the plaintiffs and not the rest of the country – found that there are “serious questions” about whether the new rules violate President Barack Obama’s Affordable Care Act, which stipulated that employer insurance plans must provide birth control services at no cost. Under Curren law, only explicitly religious organizations may opt out, so long as they could demonstrate a religious objection……The Planned Parenthood Action Fund, the nonprofit political arm of Planned Parenthood, said Sunday: “Birth control IS health care – no matter what the Trump-Pence administration thinks or whether your boss agrees with it.” January 15, 2019: Health Affairs posted an article titled: “Two Judges Block Final Rules On Exemptions From Contraceptive Coverage Mandate”. It was written by Katie Keith. From the article: On January 13 and 14, 2019, two courts – one in California and one in Pennsylvania – issued new preliminary injunctions to halt enforcement of the Trump administration’s final rules on religious and moral objections to the Affordable Care Acts (ACA’s) contraception mandate. Those rules were scheduled to go into effect on January 14. The injunction issued in Pennsylvania applies to all 50 states and DC – meaning the new rules that would dramatically broadened religious and moral exemptions to the contraceptive mandate are now on hold. In the meantime, the Obama-era accommodation to the contraceptive mandate remains in effect.This is the second time that the two judges – Haywood S. Gilliam, Jr. of the Northern District of California and Wendy Beetlestone of the Eastern District of Pennsylvania – have enjoined the contraceptive exemption rules. In December of 2017, both judges issued nationwide preliminary injunctions against the Trump administration’s interim final rules. These cases were appealed to the Ninth Circuit Court of Appeals and the Third Circuit Court of Appeals.Given the few changes made between the interim final rules and the final rules, this outcome is not surprising. Both courts had concluded that the states were likely to succeed in their claim that the rules were procedurally flawed because they were published without opportunity for public comment. Judge Beetlestone additionally found the interim final rules to be substantively improper under the Administrative Procedure Act (APA). Because the final rules largely maintained the interim final rules, it is unsurprising the she reached the same conclusion here… The case called State of California, et. al. v. Health and Human Services et.al went to the United States District Court Northern District of California. It was heard by United States District Judge Haywood S. Gilliam, Jr. The judge ruled that the preliminary injunction applies only to the five states – California, Delaware, Maryland, New York, and Virginia – that brought the lawsuit. The case called “Commonwealth of Pennsylvania and State of New Jersey v. Donald J. Trump, Alex M. Azar II, United States Department of Health and Human Services, Steven T. Mnuchin, United States Department of The Treasury, Rene Alexander Acosta, The United States Department of Labor, and The United States of America – and Little Sisters of the Poor, and Saints Paul and Peter Home” went to the United States District Court for the Eastern District of Pennsylvania. It was heard by United States District Court Judge Wendy BettleStone. Her ruling applies to all 50 states and the District of Columbia. January 15, 2019: The American College of Obstetricians and Gynecologists posted a statement titled: “ACOG Applauds Nationwide Injunction on Contraceptive Regulations”. From the statement: Lisa Hollier, M.D., M.P.H., president of the American College of Obstetricians and Gynecologists, issues the following statement regarding the Trump-Pence administration’s Religious Exemptions and Accommodations for Coverage of Certain Preventative Services Under the Affordable Care Act and the Moral Exemptions and Accommodations for Coverage of Certain Preventative Services Under the Affordable Care Act:“Access to contraception is an essential component of women’s health care. The American College of Obstetricians and Gynecologists (ACOG) applauds the two federal court decisions that enjoined the implementation of the Trump-Pence regulations that would prevent many women from accessing contraception. ACOG is especially relieved that the Pennsylvania court issued a nationwide injunction, protecting all women throughout the country who would have been negatively impacted by the regulations.“The Trump-Pence regulations threaten the health of women and families throughout the United States, undermine established law under which comprehensive preventative women’s health care has been widely accessible and disrupt the patient-physician relationship. The California and Pennsylvania courts recognized this harm and understood that contraception is important preventative health care. ACOG, along with other medical societies, submitted amicus briefs in both cases, explaining the very real harms to women and the public health.“As the nation’s largest professional organization for women’s health care physicians, ACOG recognizes contraception as an integral component of women’s health care and opposes any policy that seeks to restrict or eliminate women’s meaningful access to the full range of contraceptive methods. “ACOG’s message is simple and consistent: Don’t turn back the clock on women’s health.” January 17, 2019: The Associated Press posted an article titled: “Trump administration proposes higher ‘Obamacare’ premiums”. From the article: The Trump administration on Thursday announced proposed rule changes that would lead to a modest premium increase next year under the Affordable Care Act, potentially handing Democrats a new presidential-year health care issue……The latest details were in a 300-page proposed regulation released Thursday afternoon by the Centers for Medicare and Medicaid Services.The agency said the reason for the change was to more accurately calculate premium subsidies under the law. About 10 million people who don’t get health insurance on the job purchase individual policies under the ACA, and roughly 9 in 10 receive taxpayer-provided assistance with their premiums.The administration is also proposing to require insurers that cover abortion to offer a “mirror” plan that does not. The health law allowed insurance to offer coverage for abortions provided they collect a separate premium to cover the cost. Many states, however, have enacted laws that prevent ACA from covering abortion……In this regulation, the administration estimated that the government would save about $900 million a year on subsidies, and that 100,000 consumers would drop their coverage… January 18, 2019: CBS News posted an article titled: “Obamacare premiums could increase next year under proposed rule change”. From the article: The Trump administration on Thursday announced on Thursday announced proposed rule changes that would lead to a modest premium increase next year under the Affordable Care Act, potentially handing Democrats a new presidential-year health care issue.The roughly 1 percent increase could feed into the Democratic argument that the Trump administration is trying to “sabotage” coverage for millions. The administration said the proposal is intended to improve the accuracy of a complex formula that affects what consumers pay for their premiums….…The latest details were in a 300-page proposed regulation released Thursday afternoon by the Centers for Medicare and Medicaid Services.The agency said the reason for the change is to more accurately calculate premiums subsidies under the law. About 10 million people who don’t get health insurance on the job purchase individual policies under the ACA, and roughly 9 in 10 receive taxpayer-provided assistance with their premiums.The administration is also proposing to require insurers that cover abortion to offer a “mirror” plan that does not. The health law allowed insurers to offer coverage for abortions provided they collect a separate premium to cover the costs. Many states, however, have enacted laws that prevent ACA plans from covering abortion……In the regulation, the administration estimated that the government would save about $900 million a year on subsidies, and that 100,000 customers would drop their coverage… January 20, 2019: Forbes posted an article titled: “As Shutdown Drags On, Worries Emerge About Spikes in Obamacare Premiums”. From the article: The government shutdown has raised worries some American may have a tough time paying their health insurance premiums for individual coverage purchased under the Affordable Care Act.Health insurance companies say the shutdown’s impact should be limited to those who didn’t file a timely tax return last year, but members of Congress worry it could be broader given the millions of Americans who buy individual coverage known as Obamacare.The largely unfunded Internal Revenue Service and U.S. Treasury department handle paying “advanced premium tax credits,” which some Democrats in the U.S. House of Representatives and U.S. Senate say could be delayed and wreak havoc on how premiums are paid……The IRS has a role with the ACA’s individual coverage to verify income and other information from health plan enrollees……Despite concerns, health insurance companies have yet to report any harm from the shutdown. But health insurers are expected to address the government shutdown as they report their full year 2018 and fourth quarter earnings in the coming weeks… January 22, 2019: WRVO posted an article titled: “Legislature passes abortion rights bill, Cuomo signs it into law”. It was written by Karen Dewitt. From the article: The New York State Legislature voted Tuesday to codify the abortion rights in the U.S. Supreme Court decision Roe v. Wade into New York law, and Gov. Andrew Cuomo signed it into law immediately after the vote……The measure establishes in New York state law the right to choose abortion without restriction up to the 24th week of pregnancy, and after that, if the life or health of the mother is threatened or the fetus is determined not to be viable.Senate Democratic Majority Leader Andrea Stewart-Cousins, who achieved her post when Democrats won several seats in last November’s elections, said the bill is a top priority at time when President Donald Trump’s appointments to the Supreme Court threaten the landmark decision……The Democratic-led State Assembly already had approved the measure several times. Assembly Speaker Carl Heastie, speaking at a packed press conference attended by supporters, said Republicans who used to lead the Senate blocked the bill from coming up for a vote for 12 years……Both houses of the Legislature also approved a measure known as the Comprehensive Contraceptive Act that would ensure that New York’s women have access, through their health insurance policies, to affordable contraception. The New York Assembly website has more information about the bill titled: “An act to amend the public health law, in relation to enacting the reproductive health act and revising existing provisions of law regarding abortion; to amend the penal law, the criminal procedure law, certain provisions of the public health law relating to abortion; to repeal certain passages of the education law relating to the sale of contraceptives; and to repeal certain provisions of the penal law relating to abortion”. The New York Assembly website information about this bill also shows the committee votes. January 22, 2019: Judge Michael D. Huppert, District Court Judge, Fifth Judicial District of Iowa ruled on the case called Planned Parenthood et al v. Governor Kimberly Reynolds et. al. The case is about an anti-abortion law that was passed in Iowa. This Plaintiffs (Petitioners) in this case were: Planned Parenthood of the Heartland, Inc., Emma Goldman Clinic and Jill Meadows M.D. The Defendants (Respondents) in this case were: Kim Reynolds, ex. rel. State of Iowa and Iowa Board of Medicine. From the ruling: …This is an action brought by petitioners challenging the constitutionality of recent legislation passed by the Iowa Legislature (Iowa Code chapter 146C) which would prohibit abortion upon the detection of a fetal heartbeat by means of an abdominal ultrasound, in cases that do not involve a medical emergency or when the abortion is medically necessary (defined generally within the statute as involving rape, incest, miscarriage, or fetal abnormality.). …The petitioners take the position that this legislation violates the due process and equal protection provisions of the Iowa constitution; specifically, they argue within the present motion the such a determination can be made in advance of trial as a matter of law. The respondents resist, primarily on the basis that genuine issues of material fact remain that must await a trial on the merits. For the reasons noted within this ruling, the court agrees with the petitioners and grants the motion for summary judgement……The focus of the respondent’s factual challenge to the motion revolves around at what stage of a pregnancy is a fetal heartbeat detectable. While conceding that a fetal heartbeat can be detected as early as six weeks into a pregnancy the respondents content that such detection is ordinarily not detected until later, especially when using an abdominal ultrasound as mandated by the statute. The affidavit of the respondents’ expert, Dr. Kathi Aultman, states that the earliest a fetal heartbeat can be detected abdominally is 7 weeks, with most detected by 8 to 9 weeks, and some not until 12 weeks into the pregnancy……Regardless of precisely when a fetal heartbeat may be detected in a given pregnancy, it is undisputed that such cardiac activity is detectible well in advance of the fetus becoming viable. Within Dr. Meadows’ affidavit is the statement that the current 20-week post fertilization statutory limit for abortions under Iowa law…”is a minimum of several weeks before any fetus would be viable…. This contention is not challenged within the respondent’s resistance; to the contrary, the respondents contend that “viability…[is not] material to this case.”… To the contrary, viability is not only material to this case, it is dispositive on the present record……While the framework first announced in Roe has been modified over the years, the threshold of viability as a check on the state’s compelling state interest in promoting potential life has remained intact. In Planned Parenthood of Southeastern Pennsylvania v. Casey… (1992)… the United States Supreme Court established an “undue burden” standard in analyzing state restrictions on provability abortions… (“An undue burden exists, and therefore a provision of law is invalid, if its purpose or effect is to place a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability”). However, in doing so, the court went out of its way to make it clear that the “adoption of the undue burden analysis does not disturb the central holding of Roe v. Wade…[that] a State may not prohibit any woman from making the ultimate decision to terminate her pregnancy before viability.” … Finally in its most recent discussion of the issue, the United States Supreme Court restated (“assume[d]”) this part of the holding in Roe as reaffirmed by Casey. … Gonzales v. Carhart… (“Before viability, a State ‘may not prohibit any woman from making the ultimate decision to terminate her pregnancy'”)……Faced with the uphill battle created by this body of authority, the respondents argue in the alternative that Iowa Code chapter 146C does not impose a ban on abortions, but merely creates a window of opportunity for women to be vigilant in the exercise of their right to terminate a pregnancy; in other words, if women are to be able to exercise this right they must also exercise the concomitant responsibility to monitor the potential of a pregnancy and terminate that pregnancy prior to the detection of a fetal heartbeat. This argument is nothing more than an attempt to repackage the undue burden standard rejected by the Iowa Supreme Court in PPH II….(“[T]he undue burden standard solely measures the impact the regulation has some women’s ability to receive the procedure”). The respondents’ argument, by acknowledging the admittedly narrow amount of time afforded under the statute, “would regulate the individual rights of Iowa women to something less than fundamental.” … In actuality, the argument would probably require women to engage in a level of diligence resembling something along the lines of “mov[ing] heaven and earth,” a type of restriction the Iowa Supreme Court found to be antithetical to the notion of a fundamental right.In summary, it is undisputed that the threshold for the restriction upon a woman’s fundamental right to terminate a pregnancy (the detection of a fetal heartbeat) contained within Iowa Code 146C constitutes a prohibition of provability abortions. As such, it is violative of both the due process and equal protection provisions of the Iowa Constitution as not being narrowly tailored to serve the compelling state interest of promoting potential life. Accordingly, this court grants the petitioners’ motion for summary judgement and declares Iowa Code chapter 146C unconstitutional and therefore void… January 22, 2019: CBS News posted an article titled: “Florida bill would ban abortions if fetal heartbeat detected”. It was written by Danielle Garrand. From the article: A bill filed by a Florida state lawmaker aiming to ban abortion if a fetal heartbeat is detected has led to public outcry from some progressive groups, with one advocate stating it’s “among the most extreme” ever filed in the country.House Bill 235, filed by Republican Florida state Rep. Mike Hill, would make it illegal for women to get an abortion after a fetal heartbeat is detected……Hill’s Bill would require doctors to provide an examination for a “detectable fetal heartbeat” on women seeking an abortion and inform them if there is a heartbeat, as well as review the results of the exam.Women who decline to review the results, need to do so in writing.The fetal heartbeat is usually detected when a woman is around six weeks pregnant. Women typically discover within four to seven weeks that they are pregnant, according to the American Pregnancy Association.According to the bill, any person who provides an abortion after a heartbeat is detected commits a third-degree felony……[Amy] Weintraub [reproductive rights director for Progress Florida], said this kind of restriction would make it difficult for most women to discover they are pregnant an arrange for an abortion procedure in time……And, she said, it would disproportionately impact low-income women……The bill does permit an abortion in cases of incest, rape, human trafficking, with “a copy of a restraining order, police report, medical record, or the court order or documentation” to prove the claim.Additionally, an abortion can be provided if a woman has been diagnosed with a condition that “would create a serious risk of substantial and irreversible impairment of a major bodily function if the woman delayed terminating her pregnancy.”Currently in Florida, abortions are banned after 24 weeks of pregnancy, unless the mother’s life is in danger or her physical health is seriously compromised. The bill also strikes “fetus” from current abortion-related laws replacing the word with “unborn human being,” defining it as “an individual organism of the species Home sapiens from fertilization until live birth.”… February 1, 2019: Reuters posted an article titled: “U.S. judge throws out Maryland bid to protect Obamacare law”. It was written by Laurence Hurley. From the article: A U.S. judge on Friday threw out the state of Maryland’s bid to protect the healthcare law known as Obamacare in a ruling that also sidestepped a decision on whether President Donald Trump’s appointment of Matthew Whitaker as acting attorney general was lawful.In a win for the Republican president, Baltimore-based U.S. District Judge Ellen Hollander said Maryland had failed to show that the Trump administration is likely to terminate enforcement of the 2010 law, officially called the Affordable Care Act.The claim made by Maryland Attorney General Brian Frosh, a Democrat, “consists of little more than supposition and conjecture about President Trump’s possible actions,” Hollander wrote……Frosh said in a statement that Hollander’s decision does not end his effort to defend the law… February 2, 2019: The Hill posted an article titled: “Trump predicts ObamaCare will be ‘terminated’ by the courts”. It was written by Peter Sullivan. From the article: President Trump said in an interview published Friday that he thinks ObamaCare will be “terminated,” predicting that a lawsuit challenging the 2010 health care law will succeed……Trump was referencing a lawsuit seeking to overturn ObamaCare that was brought by Texas and other GOP-led states. A federal district court judge in Texas ruled against Obamacare in December.But the decision by the judge, appointed by former President George W. Bush, is being appealed and legal experts in both parties are very skeptical that the lawsuit will ultimately succeed… February 2, 2019: The Detroit News posted an article titled: “Michigan set to join other Dem states in lawsuits to support Obamacare”. It was written by Beth LeBlanc. From the article: The state of Michigan will join more than a dozen states with Democratic attorneys general to oppose a Texas federal court ruling that found the Affordable Care Act was unconstitutional.Democratic Attorney General Dana Nessel and Gov. Gretchen Whitmer said Thursday that Michigan would join a group of intervening states supporting the program known as Obamacare, noting that Michigan has a “strong interest” in the success of the lawsuit……If the decision from the Texas federal court is upheld, families across Michigan will struggle to get the care they need, Whitmer said in a statement…U.S. District Judge Reed O’Connor in December ruled in favor of Republican states challenging the law, finding that when Congress repealed the tax penalty for not buying insurance in 2017 it invalidated the Affordable Care Act.His ruling, which came at the end of the six-week open enrollment period for the 2019 Obamacare program, will likely be appealed to the U.S. Supreme Court……Nessel’s announcement Thursday came shortly after she withdrew the state from eight abortion, discrimination, and religious freedom lawsuits her predecessor entered during his tenure. February 2, 2019: The Hill posted an article titled: “House Dems to mull bills to overturn ObamaCare actions”. It was written by Peter Sullivan. From the article: Democrats on the House Energy and Commerce Committee on Wednesday announced that they would hold a hearing next week to consider legislation to overturn conservative actions President Trump has taken on the Affordable Care Act.The panel will consider bills to overturn Trump’s expansion of cheaper, skimpier insurance plans that Democrats deride as “junk plans,” and to restore funding for outreach efforts to enroll people in ObamaCare plans, funding that was slashed by the Trump administration.A third bill would overturn guidance from the Trump administration that makes it easier for states to make conservative changes to ObamaCare. The hearing is part of an effort by the New Democratic House majority to highlight what they call Trump’s “sabotage” of the ACA, and take actions to reverse it.The bills likely have no chance of passing through the GOP-controlled Senate, but they provide Democrats a chance to show their priorities and highlight Trump’s actions.Rep. Anna Eshoo (D-Calif.), the chairwoman of the Energy and Commerce health subcommittee, announced the upcoming hearing during a separate hearing on Wednesday on a lawsuit brought by GOP-led states seeking to overturn ObamaCare……Republicans on Wednesday also reiterated a call they made on Tuesday for a hearing on Medicare For All, saying Democrats should allow the liberal idea to be examined to show its weaknesses… February 5, 2019: Dallas News posted an article titled: “Abortion, transgender health protections should be ‘wiped permanently’ from Obamacare, says Texas AG Ken Paxton”. It was written by Laura McGaughy. From the article: Texas Attorney General Ken Paxton has asked a federal judge to ax health protections in the Affordable Care Act for transgender Americans and women seeking abortions.On Monday, Paxton and leaders from seven other states filed a motion in federal court to undo rules that bar discrimination based on “gender identity” and “termination of pregnancy” in the act, also known as Obamacare.The enforcement of the protections have been on hold for more than two years, but Paxton says it’s time to eliminate them once and for all……The Affordable Care Act prohibits hospitals and other health providers that receive federal money from denying care on the basis of race, color, national origin, age, disability, or sex. In the final months of President Barack Obama’s tenure, his administration released new regulations interpreting “sex” discrimination to include “gender identity” and “termination of pregnancy”, meaning hospitals or health care programs who turn away transgender Americans or women seeking abortions could be denied federal funds.The implementation of these regulations has been on hold since December 2016, when District Judge Reed O’Connor issued a nationwide injunction prohibiting their enforcement. The federal government wanted revisit its definition of sex, and is expected to rescind these protections, but hasn’t formally done so.The delay has irked Paxton and other conservative leaders who have fought to outlaw abortion and who oppose extending more rights to gay, lesbian, bisexual, and transgender Americans… February 5, 2019: Reuters posted an article titled “Insurers as top court to restore Obamacare ‘risk corridor’ payments”. It was written by Nate Raymond. From the article: The U.S. Government has carried out a “bait-and-switch” by withholding $12 billion owed to health insurers under an Obamacare program aimed at encouraging them to cover previously-uninsured people, an insurers told the U.S. Supreme Court on Monday.Moda Health Plan Inc and at least three other insurers separately asked the justices to review a June ruling by the U.S. Court of Appeals for the Federal Circuit, which found that Congress had suspended the government’s obligation to make the payments… February 5, 2019: Senator Patrick Leahy (D-Vermont) posted a press release titled: “Senate Floor Statement Of Senator Patrick Leahy On Introduction Of The CREATES Act” on his official website. From the press release: …Lawmakers across the political spectrum, including President Trump, agree that Congress needs to act to rein in these spiraling prescription drug prices. Pharmaceutical companies should be compensated for their important work developing lifesaving treatments. But when companies engage in predatory practices at the expense of consumers, we must act. That is why today I am reintroducing the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act, bipartisan legislation to end inappropriate delay tactics that are used by some brand-name drug companies to block competition from more affordable generic drugs. I am glad to be joined by Senators Grassley, Klobuchar, Lee and 24 other Senators of both parties in introducing this bill.The first delay tactic addressed by the CREATES Act involves the withholding of drug samples that generic manufacturers need to gain regulatory approval. Federal law requires generic competitors to prove that their low-cost alternative is equally safe as the brand-name drug with which they wish to compete. Unfortunately, some brand-name companies are preventing generic manufacturers from obtaining the samples they need to make the necessary comparison. This simple delay tactic misuses regulatory safeguards as a weapon to block competition.The second delay tactic addressed by the CREATES Act involves the development of shared safety protocols. For some high-risk drugs, Federal law requires a generic drug manufacturer to join the brand-name drug manufacturer in a single, shared safety protocol for distribution of the drug. Despite this requirement, some brand-name companies are refusing to negotiate shared safety protocols with potential generic competitors, again undermining those competitors’ ability to gain FDA approval for their generic versions of such drugs.The CREATES Act allows the FDA more discretion to approve safety protocols, rather than require parties to develop shared safety protocols. Any safety protocol approved by the FDA must meed the rigorous statutory standards already in place……The CREATES Act is one piece of the puzzle, addressing anticompetitive behavior that delays the creation of affordable generic drugs. Drug affordability is a bipartisan issue that affects each and every American. The reforms will make a difference. I hope we can finally act together to help put more affordable prescription drugs in the hands of Americans. The text of S.340 – CREATES Act of 2019 is available. The sponsor of the CREATES Act of 2019 is Senator Patrick Leahy (D-Vermont).The co-sponsors of the CREATES Act of 2019 are: Chuck Grassley (Republican – Iowa)Amy Klobuchar (Democrat – Minnesota)Mike Lee (Republican – Utah)Diane Feinstein (Democrat – California)Tammy Baldwin (Democrat – Wisconsin)Richard Blumenthal (Democrat – Connecticut)Cory A. Booker (Democrat – New Jersey)Sherrod Brown (Democrat – Ohio)Susan M. Collins (Republican – Maine)Tom Cotton (Republican – Arkansas)Ted Cruz (Republican – Texas)Steve Daines (Republican – Montana)Rickard J. Durbin (Democrat – Illinois)Joni Ernst (Republican – Iowa)Deb Fischer (Republican – Nebraska)Margaret Wood Hassan (Democrat – New Hampshire)John Kennedy (Republican – Louisiana)Angus S. King (Independent – Maine)Robert Menendez (Democrat – New Jersey)Lisa Murkowski (Republican – Arkansas)Paul Rand (Republican – Kentucky)Mike Rounds (Republican – South Carolina)Tina Smith (Democrat – Minnesota)Debbie Stabenow (Democrat – Michigan)Jon Tester (Democrat – Montana)Sheldon Whitehouse (Democrat – Rhode Island) February 7, 2019: CBS News posted an article titled: “Supreme Court Chief Justice John Roberts joins liberal justices to block Louisiana abortion clinic law.” It was written by Grace Segers and Jan Crawford. From the article: Supreme Court Chief Justice John Roberts joined the four liberal members in temporarily blocking a Louisiana law that would have closed some of the few remaining abortion clinics in the state. Justice Brett Kavanaugh wrote the dissenting opinion……The Supreme Court did not give a reason for granting the stay……The law, originally enacted in 2014, has never taken effect. The Supreme Court temporarily stayed the law last week. Justice Samuel Alito said in a brief order Friday that the justices need more time to review arguments for and against the law. The law requires doctors at abortion clinics to have admitting privileges at a nearby hospital. Should the law go into effect, abortion providers say at least one and maybe two of Louisiana’s three abortion clinics would have to close… February 12, 2019: The Chicago Tribune posted an article titled: “Kevin McCarthy blames midterm loses on GOP push to roll back health insurance protections”. It was written by Mike DeBonis. From the article: Speaking privately to his donors, House Minority Leader Kevin McCarthy squarely blamed Republican losses in last year’s midterm elections on the GOP push to roll back health insurance protections for people with preexisting conditions – and in turn blamed his party’s right flank.McCarthy’s comments, made in a Feb 6 conference call from which The Washington Post obtained partial recordings, represent a vindication of Democratic efforts to elevate health care as an issue in last year’s campaign. And in singling out the House Freedom Caucus, the remarks threaten to rekindle internal resentments inside the House Republican Conference……Elsewhere on the call, McCarthy offered a selective account of the 2017 health care battles on Capitol Hill, where Republicans in the House toiled for months to craft an alternative to the Affordable Care Act, narrowly passing a bill in may before watching the Senate abandon the effort three months later.“When we couldn’t pass the repeal of Obamacare the first way through, an amendment came because the Freedom Caucus wouldn’t vote for” the original House bill, McCarthy said. “That amendment put [the] preexisting conditions campaign against us, and so even people who are running for the very first time got attacked on that. And that was the defining issue and the most important issue in the race.”McCarthy’s account accurately describes the dynamics of passing the American Health Care Act, the Republican ACA alternative, in 2017: After an initial version of the bill was withdrawn due to opposition from both the Freedom Caucus and GOP moderates, Reps. Tom McArthur, R-N.J., and Mark Meadows, R-N.C., crafted an amendment that would give states the ability to waive protections for people with preexisting conditions… February 13, 2019: Vox posted an article titled: “Why Democrats aren’t taking up a bill to neutralize Obamacare’s latest legal threat”. It was written by Dylan Scott. From the article: …Democrats are taking up three bills to reverse the Trump administration’s sabotage The Energy and Commerce Committee will hear testimony Wednesday on a few different bills to reverse the Trump Administration’s attacks on Obamacare, usually the precursor to a bill getting a committee vote and then advancing to the House floor. A bill to repeal the Trump administration’s expansion of short-term limited-duration plans Short-term limited-duration health insurance is not required to comply with the ACA’s requirements around preexisting health conditions or essential health benefits. People can be denied coverage based on their medical history, and these plans don’t have to cover basic services like prescription drugs.And under the Trump administration’s regulations, so-called “short term” insurance – previously limited to lasting just three months – can be renewed for up to 36 months.The Trump administration projected that 200,000 or so Obamacare customers will switch from marketplace plans to short-term coverage in the coming year. Other groups project even more desertion. Those people will probably be younger and healthier, drawn to the plans by their cheaper prices and because they don’t think they’ll need robust insurance. Actuaries expect that as a result, premiums for Obamacare plans will increase as much as 10 percent on average, unless states move to regulate short-term plans more stringently.The Democratic bill would repeal the short-term insurance regulations, blocking them from going into effect. 2. A bill to block the Trump administration’s recent decision to relax regulations for plans sold on the ACA insurance marketplaces The Trump administration released new guidelines last fall that would loosen some of Obamacare’s rules for waivers that states can seek to pursue their own health care ideas. One provision would allow customers to use the law’s generous tax subsidies to pay for those short-term insurance plans, heightening the risk that more people would abandon Obamacare for Trump-approved coverage. The requirement that any waiver would cover the same number of people would also be also softened, opening up the possibility that states could get approval for waivers that actually cover fewer people.The Democratic bill would likewise block the Trump administration’s guidance from taking effect and prevent any similar changes from being implemented in the future. 3. A bill to increase funding for Obamacare enrollment and outreach efforts, which have been cut by the Trump administration The Trump administration slashed federal funding for outreach and enrollment from $100 million to $10 million in its first year and kept outreach funding at that lower level in its second year. Obamacare enrollment fell off slightly in both those years, and research has shown the many uninsured people who are eligible for the ACA’s financial assistance don’t know that the law’s marketplaces exist or that tax credits are available to them so they can buy health coverage.The Democratic bill would require the administration to perform enrollment and outreach activities and provide $100 million annually for those efforts…. February 19, 2019: The Sun-Sentinel posted an article titled: “Bill aims to protect pre-existing conditions from ‘catastrophic’ Obamacare repeal”. It was written by Ron Hurtibise. From the article: If Congress or the Supreme Court kills the Affordable Care Act, one of the act’s key provisions – that people with pre-existing conditions have access to health insurance – could be preserved for Florida consumers under a bill advanced by a state Senate committee Tuesday.How beneficial that access would be without cost controls is not yet known……Florida has the largest enrollment of the 39 states that rely on the federal marketplace. During the most recent open enrollment period from Nov. 1 to Dec. 22, more than 1.78 minion Floridians registered. That exceeded the 2018 total of 1.76 million and the 2017 total of 1.71 million.The bill by Sen. Wilton Simpson, a Republican from Spring Hill, was advanced by a 6-1 vote, with support from two of four Republicans and all for Democrats on the committee. Sen. Jeff Brandes, Republican from St. Petersburg, voted against it, and Sen. Joe Gruthers, a Republican from Sarasota, was absent.Committee Chairman Doug Broxson a Republican whose Senate district is in the western panhandle, called the protection “the right thing for Florida to do.”……But others on the committee questioned why the bill did not address the cost of premiums for the one policy covering pre-existing conditions.Simpson said “rules and restrictions” could be addressed later……The bill still faces additional Senate committees, a full Senate vote, negotiations with the House if that chamber passes a similar bill, and scrutiny from the governor… February 19, 2019: The Los Angeles Times posted an article titled: “Courts hammer Trump for sabotaging Obamacare, in rulings that could cost the Treasury billions”. It was written by Michael Hiltzik. From the article: …The most recent beneficiary of a court judgement is the Los Angeles L.A. Care Health Plan, which was awarded nearly $6 million on Feb. 14 by Judge Thomas C. Wheeler of the Court of Federal Claims. Observing that the money was promised by the ACA and that Trump had no right to stiff the insurers, Wheeler wrote that “L.A. Care Should not be left ‘holding the bag’ for taking our Government at its word.”The money is the so-called cost-sharing reduction written into the ACA. It was designed to cover a subsidy made available to buyers of ACA exchange plans with household income below 250% of the federal poverty limit, or $63,125 this year for a family of four. Those buyers receive not only a subsidy to reduce their insurance premiums, but also an additional subsidy to reduce their deductibles and co-pays……So far, more than 90 insurers, including scores brought into court as part of a class-action lawsuit, have won their cases before the Court of Claims. The rulings are coming from Wheeler and his bench colleagues Margaret M. Sweeney, who decided the class-action case on Feb. 15, and Elaine D. Kaplan, who ruled in a Montana case in September. As Bagley observed, “None of these judges bought the Justice Department’s rationale for refusing to pay. And good reason: it’s garbage.”.What’s most interesting about these rulings, experts say, is that they apply to expenses that the insurers essentially worked their way around in 2018, through a maneuver known as “silver loading.”Essentially, the insurers calculated their potential losses from the CSR suspension, then raised their premiums for benchmark silver ACA plans to cover the losses. This was done with the agreement of state regulators, including Covered California, which oversees the ACA plans in that state.Because the benchmark plans also set the levels of premium subsidies for all ACA plans, this turned out to be a boon to millions of ACA buyers – the subsidies increased to the point that they made higher-benefit gold and platinum plans cheaper and, in many cases, made lower-benefit bronze plans free for buyers. The U.S. Treasury ended up eating the higher cost……But that brings another wrinkle in the latest court rulings. For the most part, the judges say it doesn’t matter that the insurers worked around the lost cost-sharing reimbursements – the federal government owes them that money anyway, year after year. That’s the source of the $12-billion annual estimate… February 19, 2019: Journal Sentinel posted an article titled: “Wisconsin GOP senators stand against expanding BadgerCare Plus under Obamacare”. It was written by Patrick Marley. From the article: Republican state senators made clear Tuesday that they are all but certain to block Democratic Gov. Tony Evers’ plan to expand BadgerCare Plus under Obamacare.In the state budget he will introduce next week, Evers plans to accept more federal Medicaid money to make BadgerCare available to 76,000 more people. The plan would free up $280 million in state money over two years that could be used for other purposes.Republicans who control the Legislature are not on board with that idea……Republicans control the Senate 19-14 and are expected to finalize the budget without Democratic support.Republicans need 17 votes to pass a budget through the Senate, and they will be short of that number if Craig, Kapenga and Strobel oppose it… February 22, 2019: The New York Times posted an article titled: “Trump Administration Blocks Funds for Planned Parenthood and Others Over Abortion Referrals”. It as written by Pam Belluck. From the article: The Trump administration announced Friday that it will bar organizations that provide abortion referrals from receiving federal family planning money, a step that could strip millions of dollars from Planned Parenthood and direct it toward religiously-based, anti-abortion groups.The new federal rule is almost certain to be challenged in court. Clinics will be able to talk to patients about abortion, but not where they can get one. And clinics will no longer have counsel women on all reproductive options, including abortion, a change that will make anti-abortion providers eligible for funding.The rule, which has been expected for months, is the most recent step by the Trump administration to shift the direction of federal health programs in a conservative direction. The administration has expanded the ability of employers to claim religious or moral objections to the Affordable Care Act’s requirement that stye offer employees insurance coverage for contraception. It has channeled funding for teen pregnancy prevention programs and family planning grants into programs that emphasize sexual abstinence over contraception.Some of these changes are being challenged in lawsuits by groups that support reproductive rights, but the new policies have broad support among evangelicals, who are a big part of the president’s political base.The rule announced Friday is not a wholesale defunding of Planned Parenthood, a long-held goal of conservatives. Organizations receiving money through the federal family planning program, called Title X, will still be able to perform abortions but will have to do so in a separate facility from their other operations and adhere to the new requirement that they not refer patients to it.Organizations that receive federal funds have already been prohibited for years from using that money to finance abortion services. The new rule goes a step farther by ordering them to keep separate books for their abortion operations……Title X provides $286 million in funding for programs that provide services like birth control, screening for breast cancer and cervical cancer and screening and treatment for sexually transmitted diseases. These programs serve about 4 million patients each year, many of them poor, at more than 4,000 clinics. About 40 percent of those clinics are operated by Planned Parenthood, which receives close to $60 million through the family planning program each year……But several medical organization predicted that the new rule would ultimately leave large numbers of patients, especially low-income and minority women, without access to care… February 24, 2019: CALmatters posted an article titled: “Trump’s under-the-radar $1 abortion bill idea: Will it undermine Obamacare in California?” It was written by Elizabeth Aguilera. From the article: A little-noticed Trump administration proposal aims to force California’s health exchange insurers to send all their customers a second premium bill every month, for $1 – the amount the state requires to cover unrestricted abortion benefits.The Resistance State, unsurprisingly, is pushing back. State official fear that many Californians insured through the Covered California exchange will be confused about receiving a second monthly bill, and may even neglect to pay it, putting their coverage at risk. And the insurers warn that the cost and labor involved in sending multiple bills for 1.5 million people could drive up the cost of their premiums……The reason for such segregation: Federal programs, including the Affordable Care Act (Obamacare) insurance plans receiving federal subsidies, only allow abortion coverage in cases of rape, incest, or if the mother’s life is in danger, as outlined in the Hyde amendment. Conversely, California law requires insurers to include abortion services in all health care plans – an extra cost which Covered California insurers now collect by factoring an extra dollar in to the total cost of a customer’s existing monthly bill.That’s not enough, the Trump administration contends.“The administration is committed to making sure taxpayer dollars are spent appropriately,” said Seema Verma, administrator for the Center for Medicare and Medicaid Services, which is overseeing this proposed change. Her statement added that the goal is simply to enforce existing laws that require “separate” billing for abortion services.Critics see the $1 abortion bill idea as another Trump attempt to undermine Obamacare and abortion services.“This policy can only be understood as an attempt to impose an arbitrary political penalty on states offering non-Hyde abortion services,” Blue Shield of California wrote in its opposition letter to the federal government……The nonprofit insurers argued in a letter to the federal government that it already has a system in place that segregates abortion fees from federal program dollars, and predicted that the substantial costs involved in sending out double bills and replying to bewildered customers could lead to increased premiums. Blue Shield has 435,000 members in Obamacare plans.For Blue Shield, the cost could be $4 to $6 million to implement and about $900,000 monthly, Cohen said… Leading to what is expected to be a national battle over the issue, California on Monday sued the Trump administration seeking to block a new regulation that restricts access to abortion and other family-planning services.The lawsuit, which was filed in federal court in Northern California against the U.S. Department of Health and Human Services, is the first volley of what is expected to be a barrage of litigation by states, family-planning groups and others challenging restrictions prohibiting clinics that receive federal family-planning money from offering abortions or referring women to abortion services. Oregon’s attorney general said her state and 20 others, including New York, plan to file a lawsuit on Tuesday. Washington officials said last week that they plan to sue.The filing seeks an injunction against the rules adopted for Title X of the Public Health Service Act, the federally funded program devoted to family planning……The rule affects some 4 million mostly low-income people nationwide, [California Atty. General Xavier] Becerra said.California had the nation’s largest Title X program, serving some 1 million patients annually – more than 25% of all Title X patients nationwide.The lawsuit says the new rule will affect programs funded through Essential Access Health, including services provided by Planned Parenthood affiliates.The lawsuit says the new rule will affect programs funded through Essential Access Health, including services provided by Planned Parenthood.In seeking an injunction, the state argues that the federal agency has exceeded the scope of its statutory authority and acted in a manner that is arbitrary and a violation of the federal Administrative Procedure Act and the U.S. Constitution… February 26, 2019: The American College of Obstetricians and Gynecologists (ACOG) posted a statement titled: “The final Title X Regulations Disregards Expert Opinion and Evidence-Based Practices”. From the statement: The Department of Health and Human Services has released a final regulation that will significantly limit the health care available to patients under Title X of the Public Health Services Act (Title X). Leading women’s health care provider groups, medical organizations, and physician leaders representing more than 4.3 million health care providers are alarmed by the new regulation which disregards the expertise of the medical and scientific community and evidence-based standards.“As the only federal program exclusively dedicated to providing low-income patients, including adolescents, with access to family planning and preventative health services and information, Title X plays a vital role in the fabric of America’s family planning safety net. The final regulation is the latest in numerous recent decisions – from rolling back insurance coverage for contraceptives to attempting to eliminate funding for evidence-based teen pregnancy prevention programs – that unravel the threads of this safety net. Together, these decisions compound, leaving women and families with increasingly fewer options for obtaining medically accurate, affordable, and timely access to contraception and preventative care.“The new regulations weakens existing standards requiring that family planning programs funded through Title X offer a range of evidence-based contraception options. It also conditions federal funding for family planning services on a requirement that providers omit certain information in counseling patients and seeks to exclude a qualified providers from Title X.“This regulation will do indelible harm to the health of Americans and to the relationship between patients and their providers. By forcing providers to omit critical information about health care and resources available, the final regulation directly undermines patients’ confidence in their care.“There is no room for politics in the exam room. For the health of the American people, every individual must have access to comprehensive, affordable care in a safe and timely fashion, just as every provider must be able to deliver medically accurate information and care. The administration should retract this regulation and consider the record volume of comments from the medical, scientific, and patient advocacy communities. Family planning policy should be driven by facts, evidence, and necessity, not politics or ideology.” This press release was signed by: The American College of Obstetricians and Gynecologists The American Academy of PediatricsThe American College of Nurse-MidwivesThe American College of Osteopathic Obstetricians and GynecologistsThe American College of PhysiciansThe American Nurses AssociationThe American Psychiatric AssociationThe American Society for Reproductive MedicineThe American Urogynecologic SocietyThe Association for Physician Assistants and Obstetrics and GynecologyThe North American Society for Pediatric and Adolescent GynecologyThe National Association of Nurse Practitioners in Women’s HealthNurses for Sexual and Reproductive HealthThe Society for Adolescent Health and MedicineThe Society for Academic Specialists in General Obstetrics and GynecologyThe Society for Maternal-Fetal MedicineThe Society of Family PlanningThe Society of Gynecologic Oncology February 27, 2019: CBS News posted an article titled: “Senate rejects “born-alive” bill as anti-abortion advocates reignite “late-term” abortion debate”. It was written by Kate Smith. From the article: The “Born-Alive Abortion Survivors Protection Act”, a piece of legislation that echoed existing laws and medical practice, had little chance of passing in the Senate on Monday evening. And, as predicted, it ultimately failed.But its introduction and subsequent debate underscores something larger and more substantial than the bill itself: a push by the conservative right to reframe the reproductive rights debate toward third-trimester abortions……The legislation, which fell seven votes short of the 60 it needed to move forward — would have required doctors to provide care to infants who “survive an abortion or attempted abortion.” A similar bill passed in 2002, but the most recent one was different in a key way: It would have imposed fines and potential jail time for doctors who didn’t provide care.Abortion rights advocates rebuked the legislation and the theoretic surrounding it, saying that the situation described in the bill – infants surviving abortions — is an extreme rarity, only occurring in instances of abnormalities so severe that the fetus has been deemed unviable. “When you’re providing abortion care, this isn’t something that happens, Elizabeth Nash, a senior state issues manager at the Guttmacher Institute, said in a telephone interview with CBS on Monday……Mazie Hirono from Hawaii called the bill “a solution in search of a problem.”……Democrats pointed out that doctors are already required by federal law to provide care to infants born alive after an attempted abortion. “It is, and always has been, a crime not to,” Hirono said Monday… March 4, 2019: The Los Angeles Times posted an article titled: “California sues Trump administration over rules restricting abortion access”. It was written by Patrick McGreevy. From the article: Leading what is expected to be a national battle over the issue, California on Monday sued the Trump administration seeking to block a new regulation that restricts access to abortion and other family-planning services.The lawsuit, which was filed in federal court in Northern California against the U.S. Department of Health and Human Services, is the first volley of what is expected to be a barrage of litigation by states, family-planning groups and others challenging the restrictions prohibiting clinics that receive federal family-planning money from offering abortions or referring women to abortion services. Oregon’s attorney general said her state and 20 others, including New York, plan to file a lawsuit on Tuesday. Washington officials said last week that they plan to sue.The filing seeks an injunction against the rules adopted for Title X of the Public Health Service Act, the federally funded program devoted to family planning……The rule affects some 4 million mostly low-income people nationwide, [California Attorney General Xavier] Becerra said.California has the nation’s largest Title X program, serving some 1 million patients annually – more than 25% of all Title X patients nationwide.The lawsuits said the new rule will affect programs funded through Essential Access Health, including services provided by Planned Parenthood affiliates.Seeking an injunction, the state argues that the federal agency has exceeded the scope of its statutory authority and acted in a manner that is arbitrary and a violation of the federal Administrative Procedure Act and the U.S. Constitution…. The Los Angeles Times has embedded a copy of the lawsuit into that article. The lawsuit is called State of California, by and through Attorney General Xavier Becerra, v. Alex Azar, in his official capacity as Secretary of the U.S. Department of Health & Human Services; U.S. Department of Health & Human Services. March 5, 2019: The American Medical Association posted a press release titled: “AMA files suit to block administration’s Title X restrictions”. From the press release: The American Medical Association (AMA) today filed a lawsuit to block the Trump Administration’s rule that would decimate the Title X program and limit the medical advice physicians can give their Title X patients. Oregon Medical Association and Planned Parenthood Federation of America joined the lawsuit.Filed in the United States District Court, District of Oregon, the lawsuit asks the court to block the new rule. The AMA contends the rule would violate patients’ rights under the Code of Medical Ethics, would force doctors to violate their obligation to give honest and informed advice, would withhold federal family planning funding from entities that provide critical medical services to vulnerable populations, and would harm millions of patients who rely on Title X for their reproductive health….…Congress created the Title X program to ensure that all people – especially low-income women – have access to health care for family planning. Yet, the rule would eliminate current requirements that Title X sites offer a broad range of medically approved family planning options. Through the new rule, the government endorses clinics the refuse to provide all pertinent information to patients – even if the patient requests it – and endorses clinics providing misleading information……The lawsuit argues the U.S. Department of Health and Human Services’ proposed rule “blesses biases and incomplete pregnancy counseling where the interests of the patient are no longer paramount.” The rule directs physicians and other providers to give pregnant patients full information about only some of their reproductive health care options while withholding information about others.The gag rule “threatens the core of family-planning care” by interfering with communication about patients’ health care options, and sets a dangerous precedent of government interference with the patient-physician relationship. The lawsuit notes that if the rule is not blocked, it would undercut the very purpose of Title X and irreparably harm Title X providers, their patients, and the health of the nation.In the course of its 50-year history, Title X has been an enormous success for patients, their communities and our country. Title X providers serve more than 4 million patients a year. In 2017, Title X provided more than 2.8 million patients with contraceptive services and helped women avoid more than 800,000 unintended pregnancies. Without Title X, the rates of unintended pregnancy and abortion would have been 31 percent higher, according to estimates. Most of these patients served by Title X are economically disadvantaged and live in areas where there are few health care options.If the rule becomes law, vast swaths of providers would have no choice but to withdraw from Title X entirely. These consequences would be disproportionately felt by the very patients that Title X was meant to help. The lawsuit filed by The American Medical Association is called American Medical Association; Oregon Medical Association; Planned Parenthood Federation of America, Inc.; Planned Parenthood of Southwestern Oregon; Planned Parenthood Columbia Willamette; Thomas N. Ewing, M.D.; Michele P. Megregian, C.N.M., v Alex M. Azar II, in his official capacity as the Secretary of Health and Human Services; United States Department of Health and Human Services; Diane Foley M.D. in her official capacity as the Deputy Assistant Secretary, Office of Population Affairs; Office of Population Affairs March 6, 2019: NPR posted an article titled: “Trump’s Overhaul of Federal Family Planning Program Faces Multiple Lawsuits”. It was written by Sarah McCammon. From the article: Days after its official publication, a new Trump administration rule dramatically overhauling the federal Title X family planning program is facing multiple legal challenges. Several medical and reproductive rights groups, as well as 21 state attorneys general, have filed lawsuits challenging the rule, which bans any organization that provides or refers women for abortions from receiving funds through the program to provide services such as contraception and STD screenings.The latest lawsuit, filed Wednesday by the Center or Reproductive Rights, aims to block what abortion rights advocates are describing as a “gag rule.” CRR is filing the suit on behalf of Maine Family Planning, the sole Title X grantee in Maine….…Reproductive rights groups argue a dramatic shift in the Title X program could devastate networks that provide reproductive health care, including contraception, for low-income people.The filing by CRR follows a pair of related suits filed in federal court in Oregon this week, one by Planned Parenthood and the American Medical Association, and another by the group of 21 state attorneys general. They argue the rule is unconstitutional and interferes with doctor-patient communication in a way that violates federal law, including the Affordable Care Act……The National Family Planning and Reproductive Health Association has announced plans to file its own suit in the coming days on behalf of its member clinics in conjunction with a clinic in Washington state. On Monday, Essential Access Health, which administers Title X grants in California, announced a lawsuit challenging the rule on behalf of patients in that state……Unless a judge blocks the new rule, it’s set to take effect in a little less than two months. March 7, 2019: Forbes posted an article titled: “Florida Blue’s Obamacare Enrollment Steady At 1M After Rival Oscar’s Launch”. It was written by Bruce Japsen. From the article: Blue Cross and Blue Shield of Florida tallied 1.1 million Obamacare enrollees for this year, holding its own amid the aggressive entrance of startup Oscar Health into the fast-growing Orlando market.Florida Blue has successfully fought off allegations brought by Oscar that the state’s largest health insurer has engaged in monopolistic unfair business practices. Oscar entered the Florida market for the first time this year as part of a national expansion……Florida’s nearly 1.8 million Obamacare enrollees account for the biggest share of Amy of the 39 states that use the federal health insurance exchange, which makes it an attractive market for Florida Blue, Oscar and other insurers like Centene to sell individual coverage there. Nationally, enrollment via the federal health insurance exchange was more than 8.4 million, which was down slightly from 8.7 million last year, the Centers for Medicare & Medicaid Services said in January.Oscar also did well in Florida in its first year offering coverage there. Oscar signed up 31,000 members in the Orlando market, which includes enrollment from Orange, Osceola, Seminole and Lake counties…. March 8, 2019: The Associated Press posted an article titled: “Iowa court: Medicaid can cover sex reassignment surgery”. It was written by Margery A. Beck. From the article: The Iowa Supreme Court on Friday upheld a lower court’s ruling that the state cannot deny two transgender women Medicaid coverage for sex reassignment surgery.The state’s high court agreed with Judge Arthur Gamble’s ruling in June that a 1995 Iowa Department of Human Services policy denying Medicaid coverage for sex reassignment surgery violates the state’s 2007 Civil Rights Act, which added gender identity to the state’s list of protected classes.Gamble also deemed the state’s 1995 policy unconstitutional, but the high court did not address the finding… March 11, 2019: The New York Times posted an article titled: “Trump Proposes Record $4.75 Trillion Budget”. It was written by Jim Tankersley and Michael Tackett. From the article: President Trump sent Congress on Monday a record $4.75 trillion budget plan that calls for increased military spending and sharp cuts to domestic programs like education and environmental protection for the 2020 fiscal year.Mr. Trump’s budget, the largest in federal history, includes a nearly 5 percent increase in military spending – which is more than the Pentagon had asked for – and an additional $8.6 billion for the construction of a wall along the border with Mexico. It also contains what White House officials called a total of $1.9 trillion in cost savings from mandatory safety-net programs, like Medicaid and Medicare, the federal health care programs for the elderly and the poor.The budget is unlikely to have much effect on spending levels which are controlled by Congress. Democratic leaders in both the House and the Senate pronounced the budget dead on arrival on Sunday, and Mr. Trump’s budgets largely failed to gain traction in previous years, when fellow Republicans controlled both chambers……The budget would curb the growth of Medicare and Medicaid, two programs Mr. Trump had previously pledged to leave intact. And it proposes shaving $818 billion from projected spending on Medicare over 10 years and cutting nearly $1.5 trillion from projected spending on Medicaid.In place of the open-ended federal contribution to Medicaid, Mr. Trump would give states “market-based health care grants” – lump sums of federal money or per capita allotments – totaling $1.2 trillion over 10 years. Congress rejected this idea in 2017 when Republicans proposed it because it would essentially cap Medicaid payments at a fixed level and would not keep pace with rising health care costs.Mr. Trump also proposed new work requirements for working-age recipients of food stamps, federal housing support, and Medicaid, a move the administration said would reduce spending on those programs by $327 billion over a decade because it would disqualify many who currently receive assistance.Payments to a variety of health care providers would also be cut. Medicare payments to hospitals for unpaid bills and uncompensated care would be reduced by $136 billion over 10 years. Mr. Trump would cut projected Medicare payments to hospital outpatient departments by $131 billion over 10 years.In addition, the budget squeezes more than $100 billion over 10 years from Medicare payments to nursing homes and home health agencies that care for Medicare patients who have left the hospital.The president offers a suite of proposals to lower prescription drug prices,, with federal savings estimated at $69 billion over 10 years. The changes to the drug program may have the effect of increasing premiums for Americans who rely on Medicare, but they would also, for the first time, limit the amount that seniors with very expensive drugs could be asked to pay each year. Some of the plans resemble proposals unsuccessfully offered by President Barack Obama.And Mr. Trump proposed spending $26 billion less on Social Security programs, the federal retirement program, including a $10 billion cut to the Social Security Disability Insurance program which provides benefits to disabled workers. Those cuts would be achieved in various ways, including more aggressively policing fraud in the program… March 16, 2019: The New York Times posted an article titled: Judge Blocks Kentucky Fetal Heartbeat Law that Bans Abortion After 6 Weeks”. It was written by Sarah Mervosh. From the article: A federal judge on Friday temporarily blocked a Kentucky law that prohibits abortion after a fetal heartbeat is detected, which typically happens around six weeks into pregnancy, before many women know they are pregnant.The measure, which was signed into law on Friday by the state’s Republican governor, Matt Bevin, and was set to take effect immediately, was poised to become one of the strictest anti-abortion laws in the country.But late on Friday, the judge, David J. Hale of the Western District of Kentucky, ruled the law was potentially unconstitutional. He halted enforcement for at least 14 days to “prevent irreparable harm” until he could hold a hearing……The American Civil Liberties Union challenged both measures in a lawsuit filed this week on behalf of EMW Women’s Surgical Center, the state’s only licenses abortion clinic……The landscape of the Supreme Court changed last year after Justice Brett M. Kavanaugh, seems as a reliable conservative, replaced the court’s longtime swing vote, Justice Anthony M. Kennedy, who retired. The change added urgency to the question of whether Roe v. Wade, the landmark 1973 ruling that made abortion legal nationwide, would survive the Trump administration.But legal experts have suggested that any developments, at least in the near term, will most likely come at the state level, with states succeeding in smaller cases that limit – but not eliminate – the right to an abortion. Other states, including Iowa and North Dakota, have passed similarly prohibitive fetal heartbeat measures only to have them swiftly voided by the courts… March 20, 2019: Courier Journal (part of the USA Today network) posted an article titled: “Judge bars another Kentucky abortion bill Gov. Bevin signed into law”. It was written by Deborah Yetter. From the article: A federal judge has blocked Kentucky from enforcing another new abortion law, one day after it was signed into law by Gov. Matt Bevin.U.S. District Judge David Hale late Wednesday ordered the state to temporarily halt enforcement of House Bill 5, which bans abortion for reasons of race, gender, or disability of the fetus.Hale’s order comes five days after he blocked temporarily another new state law signed last week by Bevin, Senate Bill 9, which bans abortion in Kentucky once a fetal heartbeat is detected, usually around six weeks into a pregnancy. Opponents have argued it’s essentially a ban on abortion because many women don’t realize they are pregnant that early……Hale’s temporary orders blocking both laws are good for 14 days until he can hold a hearing on the matter.The ACLU is asking the federal judge to block both laws indefinitely until he rules on whether they are constitutional…The American Civil Liberties Union had sought the orders from Hale after filing a lawsuit last week, challenging both new laws as unconstitutional… March 20, 2019: Concord Monitor posted an article titled: “State, national organizations sue Trump administration to stop N.H. Medicaid work requirement”. It was written by Ethan DeWitt. From the article: Group of state and national organizations are suing the federal government to halt New Hampshire’s Medicaid expansion work requirement, arguing that the program will unlawfully lead to low-income residents being kicked off their health insurance.In a filing in the U.S. District Court for the District of Columbia submitted Wednesday, the organizations, including New Hampshire Legal Assistance (NHLA), contend that the Centers for Medicare and Medicaid Services (CMS) violated the tenets of the Medicaid Act by granting New Hampshire the authority to require individuals work 100 hours a month in order to receive health benefits.“Our concern is that folks who are eligible and working will in fact lose coverage,” Dawn McKinney, policy director at NHLA. “The majority of folks in New Hampshire on Medicaid are in working households, and their concern is just even having to file additional paperwork or navigate these requirements will cause them to lose coverage.”The class action lawsuit includes four New Hampshire plaintiffs, each of whom the organizations say will struggle to fulfill the 100-hour-per-month work requirement……In an interview, Department of Health and Human Services Commissioner Jeff Meyers said that the department has been working to ensure that no one was unfairly denied coverage under the work requirement, and would continue implementing the requirement until court intervened……Joining the NHLA in filing the lawsuit are two national organizations, the New York-based National Center for Law and Economic Justice and the Washington, D.C.-based National Health Law Program, which is serving as lead counsel. The latter organization has served as lead counsel for the two continuing federal lawsuits against the programs in Kentucky and Arkansas… March 20, 2019: Governor of Puerto Rico Ricardo Rosselló posted a press release on his official website titled: “Puerto Rico Governor Rosselló to ban so-called conversion therapy for minors”. From the press release: Puerto Rico Governor Ricardo Rosselló announced he will sign an executive order banning so-called conversion therapy for minors on the island after the U.S. territory’s House of Representatives decided not to take Senate Bill 1000 to a vote, which would have made these therapies illegal.“As a father, as a scientist, and as the Governor for everyone in Puerto Rico, I firmly believe that the idea that there are people in our society who need treatment because of their gender identity or whom they love is not only absurd, it is harmful to so many children and young adults who deserve to be treated with dignity and respect,” said Governor Ricardo Roselló.“I strive for Puerto Rico to be a society in which everyone, regardless of whom they love, can be accepted and live without fear of persecution. This includes society’s most vulnerable, our children, who should be supported and loved. Conversion therapy in no way benefits anybody, it only causes unimaginable pain and suffering.”Almost 50 years ago, the American Psychiatric Association declared that homosexuality is not a mental illness and therefore does not need to be “cured” or “treated” in any way.The Executive Order will be signed in the coming days. March 21, 2019: Planned Parenthood posted a press release titled: “Breaking: Gov. Signs Sweeping Abortion Ban in Mississippi”. From the press release: Today, Mississippi’s Governor signed a dangerous and unconstitutional six-week abortion ban. This law bans abortion in the state before many women even know they are pregnant. Mississippi is one of 15 states to introduce six-week abortion bans this year as part of an aggressive anti-abortion agenda sparked by the Trump administration and the addition of Brett Kavanaugh to the Supreme Court. Despite state politicians and courts continuing to erode Roe v. Wade and abortion access, poll after poll shows Americans want to protect access to safe, legal abortion. If Roe is overturned, 25 million women of reproductive age could lose abortion access altogether. In Mississippi, women could immediately lose access to abortion if this new law is allowed to take effect.Several other states, like Oklahoma, Kentucky, and Tennessee, are actively pursuing legislation that would immediately ban abortion outright if Roe v. Wade is overturned. With Kavanaugh on the Supreme Court and Trump in the White House, it’s clear that anti-abortion politicians are emboldened — pushing lies and misinformation about abortion, and doing just about anything to make abortion inaccessible in this country.While some politicians push these harmful policies, Trump has also ignited a powerful counter-trend in positive policies. In fact, reproductive rights advocates in more than half the sates are fighting back, advancing legislation that would protect and expand access to reproductive health care including safe, legal abortion……Court after court, including in North Dakota, Iowa, Kentucky, and Mississippi, have struck down similar bans finding them unconstitutional. Yet Mississippi is ignoring well-settled law and putting women and doctors at risk in the process. The press release included a statement from Dr. Leana Wen, President of Planned Parenthood Federation of America: “Mississippi’s six-week abortion ban is a dangerous policy that criminalizes a safe, standard medical procedure and will endanger women’s lives. I know firsthand just how important it is for doctors to have the ability to provide the care that our patients need. Patients must be empowered to make their own health care decisions, in consultation with their doctor and their family, and doctors must be able to provide health care to our patients without the threat of prison time. We cannot accept a world where the right to abortion care depends on where you live or how much money you make. Planned Parenthood will fight to ensure our patients have access to safe, legal abortion in Mississippi and across the country.” March 21, 2019: The New York Times posted an article titled: “Mississippi Bans Abortions if Heartbeat Can Be Heart. Expect a Legal Fight.” It was written by Timothy Williams and Alan Blinder. From the article: Phil Bryant, the Republican governor of Mississippi, on Thursday signed a bill largely banning abortions once doctors can detect a trace of a fetal heartbeat with an ultrasound, a milestone that can come as early as six weeks into pregnancy.Mississippi is only the latest state to press for the strict abortion limit – the sort that has already been passed and then blocked in the courts in states including Kentucky, which approved it earlier this month, and Iowa, where a law passed last year was struck down by a state court in January. Another 10 states also are debating bills to ban abortions once fetal heartbeats are found, a point at which some women and girls are not yet aware that they are pregnant….…The measures clash with Supreme Court decisions that have recognized a woman’s right to an abortion until a fetus is viable outside the womb, usually around 24 weeks into pregnancy. And opponents of abortion say that is part of the intent: To land a new case before the Supreme Court in hopes of setting sharper limits or even an outright ban. The confirmation of Justice Brett M. Kavanaugh – and the potential shifting of the court’s direction – has provoked new urgency among critics of abortion……Florida, Missouri, Ohio, Tennessee, and Texas are among the states expected to approve fetal heartbeat measures this year…..In several states this year, including Oklahoma, seek to add abortion to felony homicide laws, potentially sending doctors to prison…And a relatively new strategy in limiting abortions would ban the procedure if the reason for it was Down syndrome. Utah, Arkansas, Missouri and Kentucky are considering such bills this year, which also prohibit abortions based on gender, race, or color. Kentucky’s law signed Tuesday by Gov. Matt Bevin, was temporarily blocked by a federal court judge the next day.Ohio, Tennessee and several other states are also considering so-called trigger laws, which would immediately ban abortions if Roe v. Wade was overturned. Arkansas approved a trigger law last month……Arkansas, which five years ago saw a court strike down its ban on abortions after 12 weeks if a heartbeat could be detected, this month narrowed the period from 20 weeks to 18 weeks, in which abortions are permitted under state law. Asa Hutchinson, the state’s Republican governor, signed the bill into law last month……Mississippi, which as a single abortion clinic, often takes some of the country’s most aggressive stands against abortion rights. In November, a federal judge blocked state law that would have banned abortions after 15 weeks……If the courts ultimately uphold Mississippi’s 15-week ban, a similar law will take effect in Louisiana. March 21, 2019: Wisconsin Public Radio posted an article titled: “JudgeBlocks GOP Laws Passed In Lame Duck Session”. It was written by Shawn Johnson. From the article: A judge has struck down the laws Wisconsin Republicans passed in December’s lame-duck session of the Legislature, restoring powers to Democratic Gov. Tony Evers, if only temporarily.Dane County Judge Richard Niess ruled Thursday that all of the laws and appointments passed by legislators were unlawful because they met in what’s known as an “extraordinary session,” which isn’t explicitly allowed under the state constitution.“There can be no justification for enforcement of the unconstitutional legislative actions emanating from the December 2018 ‘Extraordinary Session’ that is consistent with the rule of law,” Niess wrote……Neiss rejected a request by the attorney for GOP legislators who would have “stayed” his decision, or kept the lame-duck laws in effect while this case is appealed. But the final say in the case still falls to the Wisconsin Supreme Court, where conservatives hold a 4-3 majority… March 21, 2019: The Hill posted an article titled: “Wisconsin withdraws from multistate lawsuit seeking repeal of ObamaCare”. It was written by Owen Daugherty. From the article: Wisconsin Gov. Tony Evers (D) and Attorney General Josh Kaul (D) announced Thursday they would remove Wisconsin from a multistate lawsuit seeking to repeal the Affordable Care Act, commonly known as Obamacare.Kaul filed a motion in court Thursday asking that Wisconsin be removed from the lawsuit just hours after a judge issued a temporary block on a law introduced last year by Republican lawmakers aimed at limiting Evers’s powers.The laws limiting Evers’s and Kaul’s powers were signed by former Gov. Scott Walker (R) last year during a lame-duck legislative session. While the laws were quickly challenged and ultimately blocked, they limited the new leadership from getting Wisconsin out of the ObamaCare repeal lawsuit until now.The GOP-controlled Legislature passed the laws in December in an unscheduled “extraordinary session” after Walker lost his bid for a third term to Evers……Republican legislative leaders said they would appeal the judge’s decision… March 21, 2019: Governor of Puerto Rico Richard Rosselló posted a press release on his official website titled: “Puerto Rico Governor Roselló: A woman’s right to choose, and to make healthcare decisions that affect her body, is fundamental”. From the press release: Puerto Rico Governor Ricardo Rosselló today vetoed Senate Bill 950, a piece of legislation that would dramatically limit Puerto Rican women’s constitutional right to choose, enshrined in the U.S. Constitution.“Our administration is committed to protecting every citizen’s rights and this includes a woman’s right to privacy and to decide whether or not to terminate a pregnancy” said Puerto Rico’s Governor Richard Rosselló.“We respect the beliefs of and intentions of the legislators that drafted this bill, but this legislation violates the rights guaranteed to every citizen of Puerto Rico. We cannot allow for rights established by the Constitution to be stripped away from Puerto Rican women, or from any other protected group”. The bill approved by the Puerto Rico Legislative Assembly would require parental consent for a minor to be able to have an abortion, a new requirement that would violate a woman’s right to privacy. Moreover, it imposes new structural requirements on abortion clinics, potentially forcing many to close, limiting access to quality healthcare to Puerto Rico’s most vulnerable citizens.“A woman’s right to choose, and to make healthcare decisions that affect her body, is fundamental. It has been established law in the United States for more than forty years as a result of the landmark Supreme Court ruling Roe v. Wade. We cannot – and should not – revisit past decisions in order to limit and take away fundamental rights. I will not stand for it. I am vetoing this measure and any other that would follow, in order to guarantee the right to choose, to privacy, and to freedom,” concluded Rosselló. March 22, 2019: Modern Healthcare posted an article titled: “Study: Reinsurance to cost feds $30 billion to support ACA insurers”. It was written by Robert King. From the article: Adopting a nationwide reinsurance program to bolster Affordable Care Act insurers would cost the U.S. $30.1 billion over three years, according to a new study.The study published Thursday in the Journal of Health Care Organization, Provision, and Financing projects that a reinsurance program with an 80% payment rate for expenditures between $40,000 and $250,000 would cost the federal government $9.5 billion in 2020 or $30.1 billion from 2020-2022.The $30 billion over three years is close to the $10 billion-per-year reinsurance pool for ACA marketplaces that the insurance industry wants Congress to consider. However, that proposal has run into partisan clashes over whether or add anti-abortion language to the new funding, an issue the doomed efforts in the last Congress to approve ACA stabilization.The study looked at out-of-pocket expenditures by individuals from 2015 to 2017 under an annual survey of individual households called the Current Population Survey Annual Social and Economic Supplement. It also looks at healthcare spending data from 2007 to 2016 from Medical Expenditure Panel Survey Household Component… The study was titled: “Estimated Costs of a Reinsurance Program to Stabilize the Individual Health Insurance Market: National- and State-Level Estimates”. March 22, 2019: App. (part of the USA Today Network) posted an article titled: “Phil Murphy: NJ getting its own Obamacare marketplace to guard against Trump.” It was written by Michael L. Diamond. From the article: New Jersey will operate its own health insurance marketplace in 2021 in a bid to guard against the Trump administration’s attempt to unwind restrictions of the Affordable Care Act, Gov. Phil Murphy said Friday.The decision would make New Jersey the 12th state to create its own exchange under the health care law, commonly nicknamed Obamacare. Until now, it has used an exchange operated by the federal government. And it could help the state give more residents more time to sign up.“Because we are operating on the federal exchange, we are subject to the whims of the Trump administration and directly impacted by its effort to damage and destabilize the market,” Marlene Caride, commissioner of the state Department of Banking and Insurance, said in a statement……The move by Murphy is the latest step in his attempt to shore up the Affordable Care Act, a President Barack Obama-era law that has been under fire from President Donald Trump… March 22, 2019: Vox posted an article titled: “Idaho voted to expand Medicaid. Republican lawmakers are trying to roll it back”. It was written by Dylan Scott. From the article: Idaho Republicans are working to roll back the Medicaid expansion approve by their voters in November, another case of GOP lawmakers refusing to accept a Democratic mandate to expand health care to their constituents under the Affordable Care Act, and a reminder of the complicated legacy left by the Supreme Court’s 2012 decision on the health c are law.The Idaho ballot referendum passed overwhelmingly in November, 61 percent to 39 percent. The initiative called for a no-frills expansion, extending eligibility to 138 percent of the federal poverty level ($17,200 for an individual, $29,400 for a family of three), as written in the ACA. If implemented, it would offer health insurance to an estimated 120,000 of the state’s poorest residents.But under a bill passed by the Idaho House on Thursday, Medicaid eligibility would be expanded only partially, up to 100 percent of the poverty level. People above that threshold (roughly 40,000) would have to purchase private coverage through the state’s insurance marketplace set up under the ACA instead.In addition, Medicaid beneficiaries would be required to work 20 hours a week, look for work, or be in school in order to continue receiving benefits. Exceptions would be made for children, the elderly, parents, and people “physically or intellectually unfit for employment.” If a person failed to meet that work requirement, they would lose their insurance coverage for two months before being allowed to reapply for Medicaid.There was bipartisan opposition to this plan in the Idaho House, but the bill still passed with ease because of the overwhelming Republican majority. The Idaho Senate is advancing its own plan, which preserves the full Medicaid expansion and merely includes a provision to help beneficiaries access job training and other work-related activities. Benefits would not be conditioned on work, as in the House bill…. March 23, 2019: The Hill posted an article titled: “Trump poised to roll back transgender health protections”. It was written by Nathaniel Weixel. From the article: The Trump administration appears to be ready to roll back health care protections for transgender people, and advocates are gearing up for a fight.A proposed rule from the Department of Health and Human Services (HHS) that’s expected in the coming days would make it easier for doctors, hospitals and insurance companies to deny care or coverage for transgender patients, as well as women who have had abortions.Coming on the heels of the military transgender ban, there are fears the administration could go even further and use the proposal as an opportunity to narrow the definition of gender.The administration hinted in a recent court filing that new health regulations could be published as soon as next week. The rule is expected to weaken or eliminate an anti-discrimination provision enshrined in ObamaCare.The provision says patients cannot be turned away because they are transgender, nor can they be denied coverage if they need a service that’s related to their transgender status……The existing health care rule was first issued in 2016, six years after the 2010 Affordable Care Act was signed into law. It prohibited providers and insurers who receive federal money from denying treatment or coverage to anyone based on sex, gender identity or termination of pregnancy……Transgender advocates are concerned the administration will use the lawsuit as an excuse to redefine gender.The New York Times last year reported that HHS proposed in a memo that government agencies adopt a narrower definition of gender in a way that would essentially end federal recognition of transgender individuals.No rules have been issued, but advocates say administration officials have been telegraphing their views… March 25, 2019: The National Law Review posted an article titled: “In Reversal, DOJ Now Says Whole ACA Unconstitutional”. It was written by Nate Robson. From the article: The Justice Department now believes the entire Affordable Care Act is unconstitutional, a reversal from its position this past summer when the government said changes to the individual mandate were unconstitutional but severable from the whole law.A Justice Department filing Monday night said the government believes a district court judge’s ruling that the entire Obama-era health care law is unconstitutional should be affirmed. Main Justice has a long tradition of defending the constitutionality of federal laws, and, while there are exceptions, it’s rare for the department to refuse to defend federal statutes.Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled in December that a congressional tax law passed in 2017 – which zeroed out the penalty imposed by the ACA’s individual mandate – rendered the entire health care law unconstitutional.The law, however, remains in effect while the ruling is being appealed to the U.S. Court of Appeals for the Fifth Circuit.The Justice Department’s change in course comes nearly two months after now-Attorney General Bill Bar told senators during his confirmation that he was open to reconsidering the government’s stance in the case… The National Law Review embedded a copy of the U.S. Department of Justice’s letter to the U.S. Court of Appeals for the Fifth Circuit. It said: The Department of Justice has determined that the district court’s judgement should be affirmed. Because the United States is not urging any portion of the district court’s judgement be reversed, the government intends to file a brief on the appellees’ schedule. March 25, 2019: Reuters posted an article titled: “Obamacare enrollment drop marginally for 2019”. From the article: Enrollments in healthcare plans for 2019 through the Federal Obamacare marketplace dropped marginally by 300,000 from last year, according to U.S. government figures released on Monday.The decrease in plan selections could likely be due to lower demand for exchange coverage, the Centers fro Medicare and Medicaid Services (CMS) said.About 11.4 million people signed up for 2019 healthcare plans, according to CMS.The agency also said it was issuing guidelines to allow issuers to continue certain health plans, often referred to as “grandmothered” plans, by one year. Such plans do not meet all the rules under Obamacare laws… March 25, 2019: Atlanta Journal-Constitution posted an article titled: “Georgia lawmakers approve Kemp’s plan for Medicaid, Obamacare waivers”. It was written by Greg Bluestein and Ariel Hart. From the article: The Georgia Legislature on Monday approved Gov. Brian Kemp’s proposal to give his office new powers to pursue “waiver” programs that could pave the way for a limited Medicaid expansion and ease insurance costs for some poor and middle-class Georgians.Senate Bill 106 cleared the Georgia House by a 104-67 vote mostly among party lines after more than an hour of tense debate. The proposal, which has previously passed the Senate, now heads to Kemp’s desk and he said he will “very quickly” sign it into law.Kemp unveiled the proposal shortly after his election with a promise it would improve government-funded health care access. He also vowed it wouldn’t lead to outright expansion of the Medicaid program, which he campaigned against during the governor’s race.It was staunchly opposed by Democrats, who say full-on expansion is the only way to spur the economy, cover hundreds of thousands of Georgians and help rural hospitals. Some appealed to the chamber’s pride: House Minority Leader Bob Trammell called it an “abdication” because it gives the governor broad new authority without requiring any final legislative sign-off… March 26, 2019: The Center for Reproductive Rights posted a press release titled: “Court Strikes Down North Carolina Abortion Ban”. From the press release: A federal district court struck down a longstanding North Carolina law yesterday – a law that banned abortion after 20 weeks of pregnancy, except in a medical emergency. The state amended the law in 2016 to further restrict the already narrow health exception to extremely limited health emergencies. Monday’s decision solely applies to abortions pre-viability. The lawsuit was filed by the Center for Reproductive Rights, the ACLU, and Planned Parenthood.The court’s decision will take effect in 60 days. In his opinion, Judge William L. Osteen, Jr. writes that “State law cannot impose an outright ban that prevents ‘woman [from] choos[ing] to have an abortion before viability.” Judge Osteen also references “the Supreme Court’s clear pronouncements on the pre-viability right to choose to have an abortion” as established over 40 years ago in Roe v. Wade. Furthermore, Judge Osteen noted that his ruling “accords universally with those of other federal courts that have considered the constitutionality of twenty-week bans and similar week- or event-specific abortion bans.”“Today’s decision is a victory for the women and doctors of North Carolina,” said Genevieve Scott, Senior Staff Attorney at the Center for Reproductive Rights. “This ban is unconstitutional and ignores the unique circumstances, challenges, and potential complications pregnant women face. Politicians taking medical options off the table for women at any stage of pregnancy I irrational and dangerous.”… March 26, 2019: The Guardian posted an article titled: “Trump administration pushes to completely gut Obamacare in dramatic escalation”. It was written by Erin Durkin. From the article: The Trump administration now believes that the entire Affordable Care Act should be struck down, a major shift in the federal government’s position and one that could endanger health coverage for millions of Americans with pre-existing conditions.In a letter on Monday night, the justice department said it is now backing a Texas Judge’s controversial December ruling that the healthcare law known as Obamacare is unconstitutional.Throwing out the law would end healthcare coverage for millions of people – getting rid of publicly subsidized health insurance plans sold on exchanges, the expansion of Medicaid, protections for people with pre-existing conditions, and rules letting children stay on their parent’s insurance until the age of 26……Until this week, the government’s position was that only part of the law – like its rules prohibiting insurance companies from denying health insurance or charging more to people with pre-existing conditions – should be struck down……A group of 21 Democratic states are appealing, since Trump’s justice department would not defend the law……Experts said the justice department’s new filing represented a dramatic shift in policy… March 26, 2019: Donald Trump tweeted: “The Republican Party will become “The Party of Healthcare!”. March 26, 2019: The Guardian posted an article titled: “Trump expands global gag rule that blocks US aid for abortion groups”. It was written by Julian Borger. From the article: The Trump administration has expanded its ban on funding for groups that conduct abortions or advocate abortion rights, known as the global gag rule, and has also cut funding to the Organization of American States for that reason.The new policy was announced on Tuesday by the secretary of state, Mike Pompeo……The Trump administration has already expanded the reach of the funding ban which dates back to the Reagan administration, to apply to all US healthcare assistance, totaling about $6bn.The extension of the policy announced by Pompeo would not only cut funding to foreign non-governmental organizations directly involved in abortions or abortion rights advocacy, but also those who fund or support other groups which provide or discuss abortion.Critics of the policy, also known as the Mexico City rule, say it has led to deep cuts in funding for family planning, women’s and reproductive health programs. Studies have shown that it has increased the number of abortions where the policy has been strictly enforced, by decreasing access to contraceptives and other family planning support. And by forcing women to seek backstreet abortions, the critics say it leads to more deaths of mothers and babies.Aid groups have said that the reduction of funding for primary health care clinics has affected treatment for other widespread diseases like TB, malaria and HIV….…Pompeo also said the state department would more strictly enforce a rule that bans funding for organizations the debate the issue of abortions, saying that would affect the Organization of American States (OAS)……Pompeo did not provide a dollar amount for the reduction of OAS contributions or name the OAS organ he was referring to. A letter signed by Republican senators in December, claimed that the Inter-American Commission on Human Rights and Inter-American Commission on Women were lobbying for the legalization of abortion in Latin American countries where it is banned… March 26, 2019: The Democrats in the U.S. House of Representatives created a plan to improve the Affordable Care Act. Here is some information about H.R. 1884 – To amend the Patient Protection and Affordable Care Act to improve affordability of, undo sabotage with respect to, and increase health insurance coverage, and for other purposes. This bill was sponsored by Representative Frank Pallone Jr. (Democrat- New Jersey). It has 102 co-sponsors: Richard E. Neal (D-Massachusetts)Robert C. “Bobby” Scott (D-Virginia)Steny H. Hoyer (D-Maryland)Kim Schrier (D-Washington)Gilbert Ray Cisneros Jr. (D-California)Diana DeGette (D-Colorado)Kathy Castor (D-Florida)Lori Trahan (D-Massachusetts)Angie Craig (D-Minnesota)Ann M. Kuster (D-New Hampshire)Raul Ruiz (D-California)Brendan Boyle (D-Pennsylvania)Colin Z. Allred (D- Texas)Cheri Bustos (D-Illinois)Lucy McBath (D-Georgia)Ben Ray Lujan (D-New Mexico)Ted Lieu (D-California)Scott H. Peters (D-California)Frederica S. Wilson (D-Florida)Abigal Davis Spanberger (D-Virginia)Harley Rouda (D-California)Lauren Underwood (D-Illinois)Antonio Delgado (D-New York)Susie Lee (D-Nevada)Lisa Blunt Rochester (D-DE at Large)Lloyd Doggett (D-Texas)Jimmy Gomez (D-California)Debbie Dingell (D-Michigan)Donna E. Shalala (D-Florida)Lois Frankel (D-Florida)Anna Eschoo (D-California)Albio Sires (D-New Jersey)Darren Soto (D-Florida)Shelia Jackson Lee (D-Texas)William R. Keating (D-Massachusetts)Haley M. Stevens (D-Michigan)David J. Trone (D-Maryland)Max Rose (D-New York)Ann Kirkpatrick (D-Arizona)John B. Larson (D-Connecticut)John Lewis (D-Georgia)Pramlia Jayapal (D-Washington)Sylvia R. Garcia (D-Texas)Joe Courtney (D-Connecticut)Linda T. Sanchez (D-California)Val Butler Demmings (D-Florida)Stephanie N. Murphy (D-Florida)Madeline Dean (D-Pennsylvania)Steve Cohen (D-Tennessee)Mike Thompson (D-California)Bobby L. Rush (D-Illinois)Joseph D. Morelle (D-New York)Katie Hill (D-California)Brian Higgins (D-New York)Susan A. Davis (D-California)Julia Brownley (D-California)Bill Pascrell Jr. (D-New Jersey)Elissa Slotkin (D-Michigan)Eliot L. Engel (D-New York)Andy Kim (D-New Jersey)Earl Blumenauer (D-Oregon)Jahana Hayes (D-Connecticut)TJ Cox (D-California)Mark Takano (D-California)Daniel T. Kildee (D-Michigan)Tom Malinowski (D-New Jersey)Andy Levin (D-Michigan)Jared F. Golden (D-Maine)Jefferson Van Drew (D-New Jersey)Debbie Mucarsel-Powell (D-Florida)Raul M. Grijalva (D-Arizona)Adriano Espaillat (D-New York)Janice D. Schakowsky (D-Illinois)Chellie Pingree (D-Maine)Eleanor Holmes Norton (D-MP At Large)Gregorio Killi Camacho Sabian (D-MP-At Large)Thomas R. Suozzi – (D-New York)Ron Kind (D-Wisconsin)Eddie Bernice Johnson (D-Texas)Michael F. Doyle (D-Pennsylvania)Doris O. Matsui (D-California)Jason Crow (D-Colorado)Katherine M. Clark (D-Massachusetts)Denny Heck (D-Washington)Chris Pappas (D-New Hampshire)Suzanne Bonamici (D-Oregon)Alcee L. Hastings (D-Florida)John P. Sarbanes (D-Maryland)Jackie Speier (D-California)Paul Tonko (D-New York)C.A. Dutch Ruppersberger (D-Maryland)Theodore E. Deutch (D-Florida)Rosa L. DeLauro (D-Connecticut)Jamie Raskin (D-Maryland)Nanette Diaz Barragan (D-California)Grace F. Napolitano (D-California)Ami Bera (D-California)Chrissy Houlahan (D-Pennsylvania)Sharice Davids (D-Kansas) The full text of H.R. 1884 is available. March 26, 2019: The House Committee on Energy & Commerce posted a news release titled: “House Democrats Unveil Legislation To Strengthen Protections For Pre-Existing Conditions And Lower Health Care Costs”. From the news release: House Democratic leaders today unveiled a sweeping bill that would protect people living with pre-existing conditions, lower health care costs for consumers, and reverse the Trump Administration’s harmful actions to sabotage the Affordable Care Act (ACA). The Protecting Pre-Existing Conditions & Making Health Care More Affordable Act of 2019 was introduced today by Energy and Commerce Chairman Frank Pallone, Jr. (D-N.J), Ways and Means Chairman Richard Neal (D-MA), and Education and Labor Chairman Bobby Scott (D-VA), the three Chairmen whose committees have jurisdiction over health care.The legislation strengthens protections for people with pre-existing conditions and reverses the Trump Administration’s harmful actions to sabotage the ACA. The bill also reverses the Trump Administration’s efforts to give states waivers to undermine pre-existing condition protections and stops the expansion of junk insurance plans that discriminate against consumers. The legislation would also restore critical outreach and enrollment funding that has been gutted by the Trump Administration and provide funding for navigators to assist consumers in signing up for health care.The bill would make health care more affordable by lowering health insurance premiums with strengthened and expanded affordability assistance. Specifically, the bill expands eligibility for premium tax credits beyond 400 percent of the federal poverty line and increases the size of tax credits for all income brackets. The legislation also creates a national reinsurance program to help cover the costs of consumers with expensive medical conditions, which lowers premiums for everyone, and offers funding to states to establish their own State-Based Marketplaces, which oftentimes have lower premiums… March 26, 2019: The U.S. House of Representatives posted a summary of the Protecting Pre-existing Conditions & Making Health Care More Affordable Act of 2019: Section by Section. From the summary: Title I: Make Health Care More AffordableSection 101Improve affordability and reduce premium costs for consumers. The legislation would make health care more affordable by expanding eligibility for premium tax credits beyond 400 percent of the federal poverty line (FPL), and would increase the size of the tax credit for all income brackets.Section 102Expand affordability for working families. Currently, an individual who has an offer of coverage through his or her employer can receive subsidized coverage in the Marketplaces if the cost of self-only coverage is unaffordable (i.e., the employee’s financial contribution exceeds 9.5 percent of the employee’s household income). However, some low-to-moderate-income families are locked out of receiving financial assistance by determining affordability based on the cost of self-only coverage, rather than family coverage (which is significantly more expensive). The legislation addresses this gap by ensuring that access to subsidized coverage turns on the affordability of family coverage, rather than self-only coverage, thereby expanding access to tax credits for working families.Title II: Undo Sabotage & Protect People With Pre-Existing ConditionsSection 201Protect comprehensive coverage for small business and workers. The legislation would rescind the Trump Administration’s final rule designed to destabilize and segment the individual and small group markets. The rule threatens comprehensive and affordable health coverage for small employers and individuals through association health plans (AHPs) – plans that could circumvent many of the consumer protections in the Affordable Care Act (ACA). AHPs are likely to have a destabilizing effect by incentivizing healthier individuals to leave the ACA-compliant market, thereby negatively affecting the risk pool and increasing premiums.Section 202Prevent junk plans and continue protections for consumers with pre-existing conditions. The legislation would reverse the Trump Administration’s final rule expanding short-term, limited-duration health plans, which are not required to comply with any of the ACA’s consumer protections (protections for pre-existing conditions, guaranteed issue, community rating, essential health benefits). These junk plans discriminate against people with pre-existing conditions and expanding them raises premiums and undermines the individual insurance market.Section 203Ensure plans provide comprehensive benefits. The legislation would prevent the Trump Administration from taking certain actions proposed in the 2019 Payment Notice that would undermine coverage of essential health benefits (EHBs). It would require plans to cover all EHBs, prohibit substitution of benefits across benefit categories, and ensure broad coverage of prescription drugs. The legislation would also require the Trump Administration to continue to make available standardized plans, so that consumers can make simpler comparisons of plans offered by different insurers.Section 204Undo Administration sabotage by requiring funding for navigators. The Trump Administration has cut navigators by over 80 percent. Navigators are community-based organizations who provide a critical source of unbiased information on coverage options. The legislation requires the Department of Health and Human Services (HHS) to implement a navigator program for the federally-facilitated Marketplace (FFM), and funds it at $100 million per year.Section 105Undo Administration sabotage by requiring funding for outreach and education. The Trump Administration has gutted marketing and outreach for the FFM, resulting in continually declining enrollment. Marketing and outreach are critically important to ensuring a balanced risk pool in the individual market. Covered California estimates that an aggressive marketing strategy could lower premiums by 2-8 percent. The legislation requires HHS to conduct marketing and outreach for the FFM and funds these activities at $100 million per year. The legislation also prohibits the Trump Administration from using outreach and enrollment funds to promote junk plans.Section 206Improve Marketplace stability prevent sabotage from raising premiums. A well-designed reinsurance program could offset some, but not all, of the premium increases from the individual mandate repeal and the cumulative effects of the Trump Administration’s sabotage of health insurance markets. The legislation establishes a state-based reinsurance program that would allow states to set up their own reinsurance programs, or to use the funs to provide premium subsidies or cost-sharing support. It also provides a federal default reinsurance program for states that do not opt to run their own reinsurance programs, in order to ensure that residents of all 50 states and the District of Columbia benefit from reduced premiums.Section 207Reverse Trump Administration guidance that would give sates the green light to undermine consumer protections. Section 1332 (State Innovation Waivers) of the ACA authorizes states to waive certain requirements of the law and experiment with health insurance reforms that could improve the well-being and health of their residents. The law has a clear statutory directive that states must maintain the level of benefits, affordability, and coverage provided to state residents by the ACA. The Trump Administration’s October 2018 waiver guidance weakens standards for approving these waivers by allowing states to simply demonstrate that a comparable number of residents will have access to comprehensive and affordable coverage, regardless of whether they actually enroll in that coverage, thereby allowing the Secretaries of HHS and Treasury to approve waivers that do not provide coverage that is as affordable or as comprehensive as under the ACA. The 2018 guidance also allows states to receive waiver approval for proposals that direct the ACA’s tax credit subsidies toward junk plans. The legislation would revoke the October 2018 guidance.Title III: State Innovation and TransparencySection 301Fund state health insurance education programs for consumers. The legislation provides $100 million in Consumer Assistance Program grants for states, which supports educational activities regarding health insurance, such as helping individuals file complaints and appeals, educating consumers on their rights, and assisting consumers with enrollment, as well as obtaining premium tax credits.Section 302Fund state innovations to expand coverage. Recognizing states are innovators in leading the charge to get America covered, the legislation provides $200 million a year from 2020 through 2022 in funding for states to conduct feasibility studies, pilot programs, technology upgrades, and other efforts to encourage enrollment in the individual and small group markets (including implementing a state version of an individual mandate).Section 303Preserve state option to implement health care Marketplaces. Under current law, federal funds are no longer available for states to set up state-based Marketplaces after January 1, 2015. The legislation would lift that prohibition so that states that have had a change in leadership and want to establish a state-based Marketplace can do so, and receive federal funding for planning and implementation.Section 304Promote transparency and accountability in the Administration’s expenditures of exchange user fees. It is unclear how the Trump Administration is spending funds raised from a user fee levied in issuers that is intended to be spent on exchange operations and outreach and enrollment, and whether all of those users are appropriate. For example, during 2017, the Trump Administration appears to have spent agency money filming anti-ACA propaganda videos. The legislation requires HHS to submit an annual report to Congress that includes a detailed breakdown of the Departments spending on outreach and enrollment, navigators, maintenance of Healthcare.gov, and operation of the Healthcare.gov call centers. March 26, 2019: The Center on Budget and Policy Priorities posted information titled: “House Bill Would Make Significant Progress on Health Care Affordability and Coverage”. It was written by Aviva Aron-Dine. From the information: House legislation introduced today would lower health insurance premiums by hundreds or thousands of dollars per year for more than 13 million people and extend coverage to millions more. The bill, introduced by Reps. Frank Pallone, Richard Neal, and Bobby Scott (chairs of the three committees with jurisdiction over major health care programs), would substantially improve financial assistance for people purchasing coverage through the Affordable Care Act (ACA) marketplaces, strengthen protections for people with pre-existing health conditions, and reverse Trump Administration actions that have made it harder for people to learn about and enroll in coverage.Making coverage more affordable. The bill, the Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019, would guarantee almost all consumers an option to purchase health insurance for low- moderate – and middle-income individual market consumers, reducing premiums for more than 13 million people. The bill would make financial assistance more adequate for low- and moderate- income people. While people with incomes below 400 percent of the poverty line are already eligible for premium tax credits that help them afford marketplace coverage, data suggest that low- and moderate-income people still face the greatest challenges affording coverage and care. The new bill would increase premium tax credits, thereby reducing premiums, for these customers……The bill would eliminate the income cap on premium tax credits. That means that people with incomes over 400 percent of the federal poverty line (about $50,000 for a single person, about $100,000 for a family of four) would receive financial assistance if benchmark premiums exceed 8.5 percent of their incomes. This change would be especially important to middle-income people, older people, and others with especially high premium burdens…...Premium tax credits under the bill would automatically phase out at higher income levels, because premiums are generally less than 8.5 percent of income for high-income people.The bill would allow families whose out-of-pocket premiums for employer-sponsored coverage exceed 9.86 percent of income to instead purchase individual market coverage with financial assistance. Currently, people with offers of employer coverage are ineligible for premium tax credits if the premium they would pay for self-only coverage is less than 9.86 percent of income. The bill would base affordability determinations for families on the amount they would pay for family coverage (fixing the so-called “family glitch”). Expanding coverage. The bill would make lower-cost coverage available to all 12 million of the marketplace-eligible uninsured (40 percent of those who remain uninsured despite coverage gains under the ACA), as well as to some of the 2.7 million uninsured who are currently ineligible for marketplace subsidies due to an offer of employer coverage. Millions of people would gain coverage as a result……Protecting people with pre-existing conditions. The ACA put in place crucial protections for people with pre-existing conditions. It prohibits insurers from denying coverage or charging higher premiums based on health status, prohibits annual and lifetime limits on coverage, and requires plans to cover essential health benefits such as prescription drugs, mental care, and substance use treatment. The Trump Administration has sought various ways around the protections, but the new bill would reverse these actions: It would reverse the Administration’s expansion short-term health plans. These plans are exempt from the ACA’s protections. They can and do deny coverage or charge higher premiums based on health status, exclude key benefits, and impose annual limits.It would reverse the Administration’s expansion of association health plans. These plans are also exempt from many ACA protections. That lets them structure benefits and premiums to attract healthier-than-average firms and individuals, increasing premiums for people with pre-existing conditions who continue to purchase ACA coverage in the individual or small group markets.It would revoke Administration guidance encouraging states to seek waivers directly and indirectly undermining pre-existing conditions protections.It would undo Administration changes that weaken standards for what individual market plans have to cover…. March 26, 2019: American Hospital Association (AHA) posted a press release titled: “AHA Statement on the Protecting Pre-Existing Conditions & Making Health Care More Affordable Act of 2019”. From the press release: There’s no doubt that our country needs to improve coverage and access. Today’s bill proposed by House Democrats can help achieve both. Among the many policies in the bill we support are protecting coverage of pre-existing conditions and essential health benefits, fully funding efforts to educate consumers about their coverage options, and protecting consumers from “health plans” that do not constitute true insurance, including short-term, limited-duration policies.A report we released earlier this month showed that taking steps to strengthen the current system – as this bill does – would result in more people gaining coverage than under other proposals that would fundamentally disrupt how Americans get coverage, such as a Medicare public option. America’s hospitals and health systems remain committed to working together with policymakers to ensure access for patients and better care for America. March 26, 2019: Senator Bernie Sanders (Independent) tweeted: “We must defend the ACA from Trump’s assault and protect people’s existing coverage. However, protecting the ACA will not fully solve the health care crisis. To finally guarantee health care as a right, we must take on the insurance industry and pass a Medicare for All bill. March 26, 2019: National Nurses United posted a press release titled: “Statement from National Nurses United President Zenei Cortez, RN: New Bill Introduced by Speaker Pelosi Fails to Address Underlying Needs for Providing Comprehensive Health Care” From the press releases: In response to Speaker Pelosi’s supposed new “sweeping” health care legislation unveiled today, National Nurses United President Zenei Cortez, RN issued the following strongly-worded statement:“Poll after poll has shown that the majority of Americans favor a Medicare for All, single-payer health care system over a profit-driven health insurance system. There are tens of thousands of volunteers across the country door knocking and phone banking in support of improving and expanding Medicare for All. The Medicare for All Act of 2019 (H.R. 1384) is backed by over 100 members of Congress and will guarantee health care for everyone – real patient choice, not the restrictions imposed by all private health insurance plans, without devastating out of pocket costs. We nurses find the new legislation proposed by Speaker Pelosi’s office disappointing and totally inadequate to address the health care crisis confronting our country. Now is not the time for watered-down, incremental measures that will only put a Band-Aid on a broken health care system.”“We urge Speaker Pelosi to put the full weight of the Democratic caucus behind H.R. 1384. Nurses demand a health care system that is based on patient need, not profits. At a moment when the Trump Administration is actively seeking to overturn the entire ACA, Democrats have an opportunity to show real leadership with the transformative change that will most protect all Americans. National Nurses United, along with our allies, will continue to build the grassroots movement for genuine health care justice and to push to pass Medicare for All.” March 26, 2019: The American College of Obstetricians and Gynecologists (ACOG) posted a statement titled: “ACOG Statement on DOJ’s Reversal of Position regarding the Affordable Care Act”. From the statement. Lisa Hollier, M.D., M.P.H., president of the American College of Obstetricians and Gynecologists, issues the following statement regarding the U.S. Department of Justice’s decision to contend that the entire Affordable Care Act is unconstitutional, in a reversal of its prior position:“The Affordable Care Act is an American success story. The American College of Obstetricians and Gynecologists (ACOG) strongly opposes the administration’s decision yesterday to reverse its prior position and support the full invalidation of the Affordable Care Act. ACOG calls on the U.S. Court of Appeals for the Fifth Circuit to uphold the law. Invalidation of the ACA will have a significant and devastating impact on the health and well-being of all Americans, especially women and families.“The Affordable Care Act put in place landmark women’s heath protections that are now part of the fabric of our nation. More than 55 million women have gained access to preventative services, including mammograms and contraception with no cost-sharing. And 8.7 million women have the peace of mind of having meaningful maternity care coverage.“ACOD remain vigilant in opposing any attacks on women’s health and stands firmly in support of our patients’ access to the comprehensive coverage guaranteed by the Affordable Care Act.“ACOG’s message is simple and consistent: Don’t turn back the clock on women’s health.” March 26, 2019: The American Hospital Association posted a press release titled: “Statement on the Department of Justice Decision on the Affordable Care Act”. It was posted by Rick Pollack, President and CEO of the American Hospital Association. From the press release: America’s hospitals and health systems oppose the Department of Justice’s (DOJ) misguided decision calling on the courts to strike down the Affordable Care Act in its entirety. The position is unprecedented and unsupported by the law or the facts. Millions of Americans would lose the coverage they have relied on for years. We have made too much progress in coverage and access to care for patients to go backwards.If courts were to adopt the DOJ position, Medicaid expansion would be reversed and protections for people with pre-existing conditions would cease to exist. March 26, 2019: The American College of Physicians posted a press release titled: “Internists Say that Trump Administration Stance on ACA Lawsuit Threatens Health of Millions”. From the press release: The American College of Physicians (ACP) strongly opposes the Trump administration’s call to strike down the entire Affordable Care Act (ACA). These actions will potentially jeopardize health care coverage for millions of Americans and their families. ACP firmly believes that provisions established by the ACA, including protections for patients with pre-existing conditions, are constitutional and must be upheld.While ACP welcomes discussions to improve the health care law, overturning the law would leave many Americans uninsured and make it extremely difficult for patients, particularly those who are chronically ill and underserved, to enroll in affordable and quality coverage plans. ACP fears that if the federal appeals court agrees with the Department of Justice and declares the ACA invalid, it would undermine patients with pre-existing conditions, destabilize the insurance market, and make health care simply inaccessible for many patients. Additionally, premium subsidies to make coverage affordable would end, annual and lifetime limits on coverage would return, federal funding for Medicaid expansion would be terminated, and seniors would no longer have access to no-cost preventive services.When the initial ruling in Texas vs. the United States was issued against the ACA, ACP opposed the decision and urged the ruling to be overturned. In an amicus curiae brief filed in the case, ACP, together with the American Medical Association, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry strongly opposed any lawsuit that would risk key health care provisions for patients put in place by the ACA.ACP urges the court to uphold the tenets of health care and protect vulnerable patients, especially those with pre-existing conditions. We will continue to advocate for policies that will put patients first and keep essential protections in place. The amicus curiae brief is available to view online. March 26, 2019: Reuters posted an article titled: “Second Wisconsin judge blocks Republican-backed laws curbing Democratic governor’s powers”. It was written by Brendan O’Brien. From the article: A Wisconsin judge on Tuesday blocked several laws passed by Republican state lawmakers during a December lame-duck session intended to curb the powers of newly elected Democratic Governor Tony Evers, the second such ruling in the past week.Dane County Circuit Judge Frank Remington issued a temporary injunction on legislation that requires lawmakers to approve discontinuing or settling lawsuits by the attorney general, allows them to dictate how governmental documents are written and gives them the ability to halt state rules written by Evers, court documents showed.Remington said in his ruling that the labor unions that brought the lawsuit were likely to succeed in showing the laws violate the separation of powers provision in the state constitution.It was the second ruling against the series of statutes passed in the last days of former Republican Governor Scott Walker’s administration. Democrats had criticized the legislation as a last-minute power grab…Remington did not issue a temporary injunction on laws that allow lawmakers to intervene in legal challenges to state statues and new enterprise zones…. March 26, 2019: The CT Mirror posted an article titled: “As DOJ asks court to invalidate the ACA, Connecticut joins legal fight to defend it.” It was written by Ana Radelat and Jenna Carlesso. From the article: Just as the Trump administration notified a federal court it would challenge the constitutionality of the Affordable Care Act, Connecticut joined other states in stepping up their legal defense of Obamacare.In a filing Monday with the 5th U.S. Circuit Court of Appeals, the Justice Department said it agreed with 15 Republican attorneys general that the elimination of the “individual mandate,” the requirement that most Americans have health insurance, invalidated the entire ACA……”This is a cruel attack on Connecticut families and on the American people. It’s pure political cruelty,” said Connecticut Attorney General William Tong, who is fighting the legal challenge to the ACA at the court of appeals.Connecticut and 20 other Democratic attorneys general, led by California Attorney General Xavier Becerra, filed an opening brief on Monday in the 5th Circuit in defense of the health care law……The Democratic-controlled U.S. House of Representatives has also intervened to ask the ACA be upheld in its entirety… March 27, 2019: The Texas Tribune posted an article titled: “Three Texas abortion bills pass committees, gaining momentum in Senate”. It was written by Arya Sundaram. From the article: A Senate panel approved a controversial abortion bill Wednesday regarding the rare cases of infants who survive the procedure. It’s one of three anti-abortion bills that Lt. Gov. Dan Patrick has listed among his priorities. All three have been approved by committees and sent to the full Senate.The Health and Human Services Committee approved the infant protection bill with a 6 to 2 vote. Senate Bill 23, filed by Sen. Lois Kolkhorst, the committee chair, gives teeth to an already existing statute that grants legal protections to children born after a failed abortion attempt. Doctors who fail to provide appropriate medical treatment would be charged with a third-degree felony and have to pay a fine of at least $100,000.The bill is part of a national Republican response to abortion advocates’ efforts to roll back regulations on late-term abortions in states like New York and Virginia.The U.S. Senate rejected a national version of SB 23 last month, which prompted the state-level response in Texas……Legislators and advocates who support abortion rights, however, say that the practice is very rare and unfairly criminalizes doctors. Texas reported zero live birth resulting from an abortion between 2013, when the Department of State Health Services started collecting the data, and 2016, the most recent year for which data is available……Meanwhile, another of Patrick’s priority bills, Senate Bill 22, would prohibit state and local governments from funding abortion providers.The bill from state Sen. Donna Campbell, R-New Braunfels, is the latest in a series of state decisions to slash government funding for abortion providers in Texas. In 2011, the Legislature cut the state’s family planning budget by two-thirds in an effort to limit funding for abortion providers like Planned Parenthood. In late 2016, the state kicked Planned Parenthood out of the state’s Medicaid program and cut off $3.1 million in funding – and a federal appeals court upheld that decision in January.These efforts don’t affect funding at the local level – which SB 22 seeks to change. Anti-abortion legislators singled out the Planned Parenthood’s downtown Austin clinic, which the city leases to the organization at a very low rate – a relationship that may be severed if SB 22 becomes law……The Alternatives to Abortion Information Act, Senate Bill 24 proposed by Sen. Eddie Lucio, a Democrat from Brownsville, would clarify an existing statute that requires a patient to receive certain information before getting an abortion, including a list of agencies that offer alternatives to abortion.The Senate State Affairs Committee unanimously approved the bill Monday.SB 24 states that a physician must hand the patient a hard copy of the materials – an important clarification, according to Joe Pojman, the executive director for the Texas Alliance for Life. Current law says the information must be provided in a conversation or online……On Wednesday night, state Rep. Matt Krause, R-Fort Wort, added an amendment to the 2020-21 state budget that would pump $52 million into the controversial Alternatives to Abortion program, which contracts with providers the refer pregnant woman and adoptive parents to social services… March 27, 2019: Mercer posted a survey titled: “New Mercer Survey: Employers Overwhelmingly Support Preserving Coverage for Pre-existing Conditions”. From the survey: According to a new Mercer survey conducted last month of nearly 600 employers of all sizes about their views on a number of health policy issues, the vast majority of respondents – 95% – believe it’s important that Congress preserve coverage for pre-existing conditions should the ACA be overturned. Before the ACA was signed into law, the majority of larger employers voluntarily offered group health plans that covered pre-existing conditions for individuals who lacked prior continuous creditable coverage (even though such coverage could have been delayed under pre-ACA HIPPA rules). Along with other ACA mandates, such as removing annual and lifetime dollar limits on essential health benefits, the ACA’s requirement that employer-sponsored group health plans cover pre-existing conditions for all individuals regardless of prior coverage could only have caused costs to rise….…This issue has moved into the spotlight again following Monday’s legal filing by the US Department of Justice urging 5th Circuit Court of Appeals to uphold a lower court ruling that strikes down the ACA in its entirety (Texas v. United States…). This is a change in direction for the Justice Department, which had argued that only certain parts of the ACA should be struck (like the ban on pre-existing conditions exclusions), after originally declining to defend the case at all. At the time, the Justice Department did not seek to strike down other parts of the ACA, such as Medicaid expansion and federal subsidies for individual coverage purchased on the public exchange. Now, the Justice Department says it agrees with the judge’s entire opinion and won’t challenge any part of that ruling as the case heads through the appeals process, and potentially to the Supreme Court.While employer health plan sponsors could voluntarily choose to continue pre-existing conditions without limitations, they clearly support Congressional action to maintain the mandate that bans such exclusions. In addition to believing, along with the majority of Americans, that protecting individuals with pre-existing conditions is the right thing to do, making it a universal requirement takes coverage availability off the table when people are making decisions to leave or stay in a job or look for a new one…. March 27, 2019: American Psychiatric Association posted a news release titled: “Joint Statement on Administration’s Position on Texas V United States”. From the news release: Our organizations, which represent a combined membership of more than 560,000 physician and medical student members are alarmed by the Administration’s announcement that they will no longer defend any part of the Patient Protection and Affordable Care Act (ACA) in the federal case Texas v United States. This decision places the health care of millions of Americans, including those with pre-existing health care conditions, in jeopardy.As physicians who provide a majority of care to individuals for physical and mental conditions, we know these insurance reforms and protections are essential to ensuring access to affordable health coverage for more than 130 million Americans, including the more than 31 million individuals between the ages of 55 and 64 who have at least one pre-existing condition.Throughout the 2018 election, the President and Members of Congress from both parties emphasized their commitment to protecting individuals with pre-existing health conditions. This announcement by the Administration explicitly contradicts that promise. Elimination of these protections would result in millions facing limited access to health care coverage and higher cost as a result of insurers being allowed to return to discriminatory coverage and pricing practices.The DOJ’s new position, if accepted by the courts, would endanger not only essential protections for persons with preexisting conditions, but other programs that millions of Americans depend on to ensure their access to affordable health care. These include federal funding for Medicaid expansion, premium subsidies to make coverage affordable in the individual market, and the ban on annual and lifetime limits on coverage. In addition, insurers would no longer be required to cover essential health care such as maternity care, pediatric services, cancer screenings, prescription drugs, and mental health and substance use disorder treatments. Additionally, dependent coverage up to age 26 would be discontinued, seniors would no longer have access to no-cost preventative services, and women could again be charged more for coverage simply because of their gender.Our organizations strongly disagree with the DOJ’s position. We fully support the protections and programs established by the ACA that are essential to ensuring access to care. We strongly urge the Administration to reverse its position in Texas v. United States, and even if it does not do so, we hope and expect that the appellate courts consider the impact on patients and rule against overturning the law.Our organizations stand ready to collaborate with the Administration and Congress on policy solutions to increase access to affordable health care and provides all individuals, regardless of they gender, race, and health status; and provide reasonable protections against discrimination in coverage and pricing. March 27, 2019: United States District Court for the District of Columbia Judge James E. Boasberg (nominated by former President Barrack Obama), issued his ruling on a case titled: Ronnie Maurice Steward, et. al. V Alex M. Azar II, et. all. The case was about the Commonwealth of Kentucky’s Medicaid work requirements. Here are some key points from the ruling: Kentucky HEALTH, which the Secretary (of Health and Human Services, Alex Azar II) initially approved on January 12, 2018, that Kentucky could condition Medicaid eligibility for a large portion of its beneficiaries on work or community-engagement requirements and impose several additional obligations intended to make Medicaid more like commercial insurance. Plaintiffs – Kentucky residents currently enrolled in Kentucky HEALTH, believed the Secretary’s approval to be unlawful. The United States District Court for the District of Columbia agreed with the plaintiffs.The court found that Secretary Azar “never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens” and thus promote a central objective of the Medicaid Act. The court found that Secretary Azar had not grappled with Kentucky’s estimate that a substantial number of people were likely to lose coverage under Kentucky HEALTH. The Court vacated the approval of Medicaid work requirements and remanded HHS for further review.Last November, Secretary Azar reproved the Medicaid work requirements program under somewhat different reasoning. Plaintiffs maintain that the Secretary has still not adequately considered Kentucky HEALTH’s likelihood to cause significant coverage loss.Judge Boasberg wrote: …The Supreme Court, in holding that Congress could not require states to adopt that Medicaid expansion by conditioning all their Medicaid funding on a decision to do so, explained that states could not be compelled to engage in a program not bargained for with “a gun to the head”… Kentucky, it seems, has now picked up that gun by threatening to de-expand Medicaid.Defendants urge the Court to adopt the proposition that the Secretary need not grapple with the coverage-loss implications fo a state’s proposal as long as it is accompanied by a threat that the state will de-expand – or indeed, discontinue all of Medical. By definition, so this argument goes, any number of people covered by an experimental Medical program would be greater than the number if there were no Medicaid at all; as a result, any demonstration project that leaves any individual on a state’s Medicaid rolls promotes coverage.The Court cannot concur that the Medicaid Act leaves the Secretary so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose. As a consequence, once again finding the reapproval was both contrary to the Act and arbitrary and capricious, the Court will vacate it and remand it to HHS for further review…. Here is another interesting part of the Judge’s ruling: …Taken to its logical conclusion, the Secretary’s position thus makes little sense. Under his reasoning, states may threaten that they wish to de-expand, or indeed do away with all of Medicaid – for fiscal reasons or no reason at ll – if the Secretary does not approve whatever waiver Medicaid requirements they wish to obtain. The Secretary could then always approve those waivers, no matter how few people remain on Medicaid thereafter because any waiver would be coverage promoting compared to a world in which the state offers no coverage at all. Remarkably, when asked for a limiting principle to this proposition during oral argument, Defendants did not give one… Could a state decide it did not wish to cover pregnant women? The blind? All but 100 people currently on Medicaid rolls? The Secretary offers no reason that his position would not allow for any of those results… March 27, 2019: The Washington Post posted an article titled: “A job-scare town struggles with Arkansas’s first-in-nation Medicaid Work rules”. It was written by Amy Goldstein. From the article: …This community [Marianna, Arkansas] – scarce on jobs and among the poorest in a poor state – provides an early reality check on how hard it is to carry out President Trump’s vision of a social safety net that requires most able-bodies people to work, or try to work, in exchange for government health benefits. Nearly 10 months ago, Arkansas became the first place in the nation to impose work requirements on the part of Medicaid that expanded under the Affordable Care Act. Seven other states have won the Trump administration’s blessings to begin the same idea soon, and seven more are waiting in line……”I am a big van of work and people working,” said Rep. Reginald Murdock (D), a veteran state legislator from Marianna. But with jobs so scarce here, even at at time of low unemployment statewide, “threatening people with their insurance wasn’t a proper way to do it.”On Wednesday afternoon, a federal judge in Washington threw a significant roadblock into Arizona’s program, issuing an opinion saying the rules “cannot stand,” and in a separate decision, rejecting the start of a similar program in Kentucky for a second time – decisions likely to have ripple effects on states with similar aspirations. The same jurist, U.S. District Judge James Boasberg, had delayed Kentucky’s imposition of work requirements last summer, ruling that Trump’s health aides had inadequately considered the effects on people needing insurance.Twin opinions cast doubt on the Trump administration’s re-envisioning of the public health insurance program, telling federal health officials they must reconsider the two states’ applications with an eye toward the effect on poor people who depend on such coverage.Both Arkansas Gov. Asa Hutchinson (R) and the U.S. Department of Health and Human Services Secretary Alex Azar had suggested the Arkansas program was helping people become more independent, contending most people who lost benefits have found steady work. But the state lacks data so far to back that up… March 27, 2019: United States District Court for the District of Columbia Judge James E. Boasberg (nominated by former President Barrack Obama), issued his ruling on a case titled: Charles Gresham, et al. v Alex M, Azar II, et. all. The case was about the the state of Arkansas’s Medicaid work requirements. Here are some key points from the ruling: The case was brought by ten Arkansans who came to the Court in 2018 seeking to undo the work requirements the state added in 2018 to its Medicaid program. They sued the Secretary of Health and Human Services in August 2018, arguing that the federal government’s approval of the state’s new requirements violated the Administrative Procedure Act and the Constitution.Plaintiffs pointed to the similarity of this case and the Kentucky Medicaid work requirements case. The Judge determined: “Despite the protestations in its (and intervenor Arkansas’s) briefing, HHS conceded at oral argument that the administrative decision in this case shares the same one” (as the Judge identified in the Kentucky case. “The Court’s job is thus easy in one respect, the Secretary’s approval cannot stand.”The Judge concluded: “For the foregoing reasons, the Court will grant Plaintiff’s Motion for Summary Judgment and deny Defendants’ Cross-Motions. A separate Order consistent with this Opinion will issue this day, remanding the matter to HHS”. Here are some key parts of the Judge’s ruling: To be approved (for Medicaid), state plans must comply with certain minimum parameters set out by the Medicaid Act… One such provision requires states to “make[e] medical assistance available” to low-income individuals…. Until recently, that group included pregnant women, children, and their families; some foster children; the elderly; and people with certain disabilities……In 2010, however, Congress enacted the Patient Protection and Affordable Care Act (ACA), colloquially known as Obamacare, “to increase the number of Americans covered by health insurance…. Under that statute, states can expand their Medicaid coverage to include additional low-income adults under 65 who would not otherwise qualify……Arkansas’s Medicaid program dates back to 1970. For most of the program’s history, the state maintained among the most stringent eligibility thresholds in the nation for adults, covering only the aged, disabled, and parents with low incomes… That changed with the passage of the ACA. While states had a choice after NFIB not to expand Medicaid, Arkansas was one of those which opted to do so…In its first two years, the program provided health coverage to more than 278,000 newly eligible individuals, helping to lower the uninsured rate from 19% to 11%… The program became known as Arkansas Works in January 2017… The Judge noted that in 2017, the Trump administration took over from President Obama. The Department of Health and Human Services (in short) allowed states to change their Medicaid programs.Governor Asa Hutchinson proposed three substantial amendments to Arkansas Works. First, he proposed to shift income eligibility for the expansion from 33% to 100% of the Federal Poverty Line. … Second, he proposed to “institute work requirements as a condition” of continued Medicaid coverage. Third, he proposed to eliminate retroactive health coverage. The state did not estimate the effects these amendments would have on Medicaid coverage…On March 5, 2018, Secretary Azar approved Gov. Hutchinson’s amendments and limits to retroactive coverage, concluding they were “likely to assist in improving health outcomes” and “incentivize beneficiaries to engage in their own health care.” Under the new work requirements, most able-bodied adults in the Medicaid expansion populations 19-49 must complete each month 80 hours of employment or other qualifying activities – or earn income equivalent to 80 joins of work… Compliance was required to be reported monthly through an online portal……Various groups of persons are exempt, including the medically frail, pregnant women, full-time students, and persons in drug- or alcohol-treatment programs. Nonexempt individuals who do not report sufficient qualifying hours for any three months in a plan year are disenrolled from Medicaid for the remainder of that year and not permitted to re-enroll until the following plan year… Since the program began, more than 16,900 individuals have lost Medicaid coverage for some period of time for not reporting their compliance… It is not known what percentage of these individuals completed the work requirements but did not report versus those who did not engage in the work itself Conclusion: For the following reasons, the Court will grant Plaintiff’s Motion for Summary Judgement and deny Defendants’ Cross-Motions. A separate Order consistent with this Opinion will issue this day, remanding the matter to HHS. March 27, 2019: Idaho Statesman posted an article titled: “A federal court ruling shook up Wednesday’s Idaho Senate hearing on Medicaid”. It was written by Audrey Dutton. From the article: A federal court’s ruling on Medicaid work requirements in other states threw Idaho lawmakers for a loop – coming in the middle of a hearing Wednesday afternoon on that very topic.As a result, an Idaho Senate committee rejected a House bill that would have implemented work requirements here……The bill requires low-income adults to work, volunteer or participate in job training as a condition of getting Medicaid. It carves out exemptions for several groups – parents, caregivers, people with disabilities, college students, and others.The Idaho Senate Health and Welfare Committee had just spent two hours hearing from people with opinions on the bill.Then, the news broke……The Senate Committee was informed of the court ruling. Members started asking questions: What does this mean for Idaho? Are the work requirement rules in HB 277 similar to those in Arkansas and Kentucky’s laws? How similar?After talking about the court’s ruling and the questions it raises for Idaho’s proposal, the committee vote 7-2 to hold the bill in committee… March 27, 2019: Kaiser Family Foundation posted information titled: “As All States Streamline Medicaid Enrollment and Renewal Processes, New Eligibility Requirements Pursued By Some States Could Increase Administrative Complexity and Reduce Coverage”. From the information: All states continue to implement new Medicaid enrollment and renewal processes that can connect individuals to coverage more quickly and reduce administrative paperwork, finds KFF’s annual 50-state survey of Medicaid eligibility and enrollment policies. At the same time, some states are pursuing new eligibility requirements, such as work requirements and monthly premiums that would push coverage in the opposite direction, increasing the complexity of enrollment processes and potentially reducing coverage……In the 14 states that had not adopted the Medicaid expansion, eligibility for parents and other adults remained very limited. The median eligibility level for parents in these states was 40 percent of poverty ($8,532 per year for a family of three). In Texas, eligibility is limited to 17 percent of the federal poverty level or less than $4,000 per year for a parent in a family of three. Other adults were ineligible regardless of income in all these states except Wisconsin.…some states are seeking and implementing new eligibility rules, often through waivers. Such measures include imposing work requirements, mandatory health risk assessments, charging monthly premiums, eliminating retroactive eligibility, delaying coverage until the first premium payment and locking enrollees out of coverage if they fail to pay premiums or renew their eligibility on time. Many of these measures require complex and costly documentation and administrative efforts, which can raise barriers to coverage and contribute to coverage losses, in contrast to the push for increased coverage and streamlined enrollment processes under the ACA… The full survey is titled: “Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey. It was conducted by KFF and Georgetown University’s Center for Children and Families. March 27, 2019: WGBH posted an article titled: “Mass. House Approves Title Bill with Bipartisan Support”. It was written by Chris Lisinski. From the article: The Massachusetts House voted with bipartisan support Wednesday to allocate up to $8 million for family planning providers, a move that uses state dollars to replace federal funding lost under a rule change targeting abortion services.Members voted 139-14 to authorize state funding through the end of fiscal year 2020 to cover whatever Massachusetts clinics lose under the new Trump administration rule. The bill could go before the Senate as soon as Thursday, and Republican Gov. Charlie Baker has indicated he plans to support it as well……In February, the Trump administration announced it would no longer direct Title X funding, which supports family planning services for low-income residents, toward any clinic that provides or refers abortions. The rule change faces a legal challenge from 21 states, including Massachusetts, but it will go into effect in May if it is not blocked in court……Massachusetts providers received $6.1 million from Title X in 2017, according to the Planned Parenthood League of Massachusetts, although it is unclear exactly how much of that would be affected under the administration’s new rule.[Ways and Means Committee Chair Aaron] Michlewitz told reporters about $1.6 million of the $8 million allocated would be in place through the end of fiscal year 2019 and the remainder would be available for fiscal year 2020. Lawmakers are preparing for a situation in which the state receives no Title X money whatsoever.About 75,000 Massachusetts residents, a vast majority of whom earn less than $30,000 a year, would be impacted by the cut in funding, according to Michlewitz. Opponents of the rule change, who refer to it as a “domestic gag rule,” say the move would limit access to crucial health services”… March 27, 2019: the American Academy of Family Physicians posted a statement titled: “Family Physicians Alarmed by DOJ’s Request to Invalidate Affordable Care Act”. From the statement: “The Department of Justice support of the district court’s December ruling to strike down the Affordable Care Act should alarm everyone. The ultimate outcome of this case will determine whether tens of millions of Americans will have access to necessary – and often lifesaving – medical care.“As a result of the ACA’s patient protections, insurers cannot discriminate against patients with pre-existing conditions such as asthma, diabetes or cancer. They cannot rescind coverage when a patient becomes sick. The ACA requires coverage of preventative care, laboratory tests, maternity care, emergency room services and other essential benefits. It prohibits insurance companies from capping annual or lifetime benefits and prevents discrimination against patients due to their age, medical history or gender.“Family physicians support these provisions in the ACA. The American Academy of Family Physicians would support legislative efforts to improve the ACA by expanding coverage and making services more affordable. However, eliminating the ACA is not the way to accomplish this. The AAFP will be steadfast in our support of patient protections as we continue to work for policies that ensure our patients get the care we need, when they need it.” March 27, 2019: The American Civil Liberties Union (ACLU) posted a press release titled: “ACLU Applauds Veto of Bill to Restrict Abortion Access in Puerto Rico”. From the press release: The American Civil Liberties Union applauds the decision of Puerto Rico Governor Ricardo Rosselló to veto Senate Bill 950. The House voted to override the veto, and the Senate is now considering the same. The bill, if enacted into law, would unconstitutionally restrict the reproductive rights of women in Puerto Rico, particularly young women, and deny them the ability to make important personal decisions for themselves……Federal courts have routinely struck down laws requiring parental consent for abortion when they fail to establish and adequate judicial bypass procedure allowing minors to seek permission from a court instead of a parent. Senate Bill 950 suffers from several deficiencies on this front, thereby violating U.S. Supreme Court precedent.Every minor must have the opportunity to seek a bypass on the grounds that she is mature and well-informed enough to make the decision without parental consent or that an abortion is in her best interest. However, not only does the bill not require the courts to consider either of those factors – it does not permit them to do so.The bill failed to guarantee that a minor’s bypass is heard expeditiously. Indeed, under this bill, more than two weeks could elapse between when a young woman files her petition and when she gets a decision. That is too long a time to delay anyone’s abortion decision – while abortion is extremely safe, the risks and costs of the procedure increase with delay. As courts and leading medical organizations have recognized, preventing delay is even more critical in the case of adolescents, who often do not realize they are pregnant until later in pregnancy or face other delays in accessing care.The bill’s emergency effective date would make compliance with basic constitutional requirements of a bypass impossible. As a practical mater, there is simply no way that courts, advocates, and physicians can ensure that critical safeguards for protecting a minor’s safety are in place – including constitutionally-required guarantees of confidentiality – without adequate time to develop the appropriate policies and procedures. Numerous courts have blocked parental involvement laws in just this situation. March 28, 2019: The Hill posted an article titled: “Arkansas governor asks Trump to appeal decision on Medicaid”. It was written by Jessie Hellmann. From the article: Arkansas Gov. Asa Hutchinson (R) said he’s asked the Trump administration to appeal a federal judge’s Wednesday decision to block the state’s Medicaid work requirements……HHS hasn’t said what its next steps will be, but Hutchinson said the administration is committed to work requirements for Medicaid……Judge James Boasberg of the U.S. District Court for the District of Columbia, an Obama appointee, ruled Wednesday afternoon in two separate cases that the Trump administration didn’t consider whether the work requirements met the objective of Medicaid: to provide coverage to needy populations.More than 18,000 people have lost coverage since the work requirements took effect last summer… March 28, 2019: News Channel 9 ABC posted an article titled: “Georgia’s Kemp signs bill authorizing Medicaid waiver.” From the article: Georgia’s Republican governor has signed legislation giving his office wide leeway to reshape the state’s health care system.Gov. Brian Kemp on Wednesday signed the “Patients First Act,” authorizing the state to pursue a Medicaid waiver.If approved, a waiver could give Georgia the flexibility to expand Medicaid more conservatively than federal rules typically allow. The legislation caps eligibility for any expansion to those at or below federal poverty level, limiting the number of Georgians who would ultimately be covered……Many Democrats opposed the plan, saying it would cover fewer people and cost more than full Medicaid expansion… March 28, 2019: The U.S. District Court for the District of Columbia released the ruling by U.S. District Judge John D. Bates on the case titled: “State of New York, et. al. v. United States Department of Labor, et. all”. From the ruling: Eleven states and the District of Columbia have sued the Department of Labor (“DOJ”), alleging that its final rule interpreting the definition of “employer” in the Employee Retirement Income Security Act of 1974 (“ERISA”), … is unlawful under the Administrative Procedure Act (“APA”),… DOL’s interpretation of the term “employer,”… impacts the treatment of certain healthcare plans under both ERISA and the Patient Protection and Affordable Care Act (“ACA”),… The States charge that DOL’s Final Rule stretches the definition of “employer” beyond what ERISA’s text and purpose shall bear. For the reasons that follow, the Court agrees.ERISA governs employee benefit plans arising from employment relationships. It provides that some employer associations acting “in the interest of” employer members are sufficiently employer-like to fall within the statue’s scope. Health plans offered by these associations may qualify as single ERISA plans, a designation that confers regulatory advantages under the ACA. For decades, DOL has interpreted these provisions narrowly so as to only allow so-called “bona fide associations” with close economic and representational ties to their employer members to qualify as “employers” under the statute.In 2018, the DOL abruptly reversed course, issuing the Final Rule challenged in this case. The Final Rule allows virtually any association of disparate employers connected by geographic proximity to qualify as ERISA plans. These associations no longer have to be viable apart from offering an association health plan (“AHP”) and may form solely for the purpose of creating an AHP. In addition, the Final Rule brings sole proprietors without any employees within ERISA’s scope by counting them as both “employers” and “employees.” Because the ACA defines terms key to its implementation – including “employer” and “employee” – according to the definition of these terms in ERISA, the Final Rule expands AHPs in a way that allows small businesses and some individuals to avoid the healthcare market requirements imposed by the ACA.The Final Rule is clearly an end-run around the ACA. Indeed, as the President directed and the Secretary of Labor confirmed, the Final Rule was designed to expand access to AHPs in order to avoid the most stringent requirements of the ACA… But equally important for the analysis that follows, the Final Rule does violence to ERISA. The Final Rule scraps ERISA’s careful statutory scheme and its focus on employee benefit plans arising from employment relationships. It purports to extend ERISA to cover what are essentially commercial insurance transactions between unrelated parties. In short, the Final Rule exceeds the statutory authority delegated by Congress in ERISA. For the reasons that follow, the Final Rule’s provisions defining “employer” to include associations of disparate employers and expanding membership in these associations to include working owners without employees are unlawful and must be set aside… March 28, 2019: Bloomberg posted an article titled: “Trump’s Group Health Plan Rules Struck Down as ACA ‘End-Run'”. It was written by Erik Larson and John Tozzi. One of President Donald Trump’s health-care initiatives intended as a cheaper alternative to Obamacare suffered a crucial defeat when a judge ruled the policy violates the Affordable Care Act.U.S. District Judge John Bates in Washington on Thursday blocked new rules governing so-called association health plans, or AHPs, which let businesses and individuals to band together to create group health plans that offer less expensive coverage than the ACA – but without some of its protections….…The final rule is clearly an end-run around the ACA,” Bates, a 2001 appointee of Republican president George W. Bush, said in the ruling. “Indeed, as the president directed, and the secretary of labor confirmed, the final was designed to expand access to AHPs in order to avoid the most stringent requirements of the ACA.”……The case is State of New York v U.S. Department of Labor, 18-cv-1747, U.S. District Court, District of Columbia (Washington). March 28, 2019: The Hill posted an article titled: “Rick Scott to introduce amendment protecting pre-existing conditions amid ObamaCare fight.” It was written by Tal Axelrod. From the article: Sen. Rick Scott (R-Fla.) is set to introduce an amendment to the budget Thursday to protect health care coverage for people with pre-existing conditions.Though the budget is a nonbonding document, the move comes as Republican senators seek to regain their footing after being caught off guard by the Trump administration’s renewed push to fully repeal the Affordable Care Act…“I don’t think there was any heads-up on anything that he was going to say,” Senate Finance Committee Chairman Chuck Grassley (R-Iowa), whose panel has jurisdiction over health care, said…. March 28, 2019: Senator Rick Scott tweeted: “Today at the @SenateBudget markup I will be introducing my amendment to protect health care coverage for those with pre-existing conditions.” The tweet included a link to CSPAN. March 28, 2019: Representative Sean Patrick Maloney (D-New York) posted a press release on his official website titled: “Maloney Introduces Legislation to Ban Use of Taxpayer Dollars for Conversion “Therapy””. From the press release: Today, in advance of the Transgender Day of Visibility on March 31st, Representative Sean Patrick Maloney (NY-18), a co-chair of the Congressional LGBT Equality Caucus, introduced the Prohibition of Medical Funding for Conversion Therapy Act. The bill would prevent Medicaid funds from being used to pay for conversion “therapy” and crack down on misleading billing tactics, which have allowed taxpayer dollars to fund the discredited practice. The bill is cosponsored by 63 members of Congress.“Conversion practices are discredited, harmful, and not therapy. Fundamentally, conversion tactics are based on the idea that a person’s gender identity or sexual orientation are diseases to be cured — they have no legitimate medical application and should not be used anywhere,” said Rep. Maloney. “Until we can just ban conversion ‘therapy’ all together, we must ensure taxpayer dollars aren’t funding a fraudulent practice that has been roundly discredited by the medical community. That’s exactly what my bill would do.”“The Trevor Project hears from youth harmed by the dangerous and discredited practice of conversion therapy every week. By limiting the means by which licensed mental health professionals can be reimbursed for their horrific practice, the Prohibition of Medicaid Funding for Conversion Therapy Act will make clear that conversion therapy is far outside the mainstream,” said Sam Brinton, Head of Advocacy and Government Affairs for The Trevor Project. “More than 21,000 advocates have joined the Trevor Project’s 50 Bills 50 States campaign dedicated to protecting LGBTQ youth from conversion therapy. We look forward to mobilizing them to ensure this critical legislation relieves the attention and support it deserves.”……Conversion “therapy” attempts to “cure” the sexual orientation or gender identity of members of the LGBTQ+ community. Despite being discredited by the American Psychiatric Association, American College of Physicians, American Academy of Child Adolescent Psychiatry, and other medical and civil rights organizations, thousands of innocent LGBTQ people are subjected to so-called “conversion” or “reparative therapy” each year. Research has found that the practice can lead to depression, decreases in self-esteem, substance abuse, homelessness, even suicidal behavior. According to the Williams Institute at the UCLA school of Law, hundreds of thousands of LGBTQ young people have been forced to undergo the practice.States currently decide which services Medicaid can cover and most have failed to ban the use of funding for conversion “therapy”. Because CMS codes do not mention the model of therapy being applied, even illegitimate practices can be performed and billed. The Prohibition of Medicaid Funding for Conversion Therapy Act would take several steps to combat the practice. First, it would legally define “conversion therapy” while ensuring that organizations which provide legitimate support to LGBTQ people are not at risk of losing funding. The bill would also ban the use of Medicaid funding for conversion “therapy” and ensure the practice is not paid for through the use of deceptive billing practices using CMS codes for mental and behavioral health.The bill has been endorsed by The Trevor Project, Human Rights Campaign (HRC), National Educational Association, PFLAG National, Gay & Lesbian Medical Association (GLMA), National Center for Lesbian Rights (NCLR), Council for Global Equality (CGE), National Center for Transgender Equality (NCTE), Third Way, True Colors Fund, Familia: Trans Queer Liberation Movement, Family Equality Council, AIDS United, Gay Lesbian & Straight Education Network (GLSEN), National Black Justice Coalition, National Gay & Lesbian Chamber of Commerce, National LGBTQ Task Force Action Fund, Equality California.The bill is cosponsored by Representatives: Ted Lieu, Tulsi Gabbard, Mark Takono, Suzanne Bonamici, Eleanor Holmes Norton, Alan Lowenthal, Charlie Crist, Adriano Espaillat, Eliot Engel, Andre Carson, Raul Grilalva, Steve Cohen, Derek Klimer, Michael Doyle, Debbie Mucarsel-Powell, Jimmy Gomez, Betty McCollum, Chris Pappas, Earl Blumenauer, Eric Swalwell, Paul Tonko, Gregory Meeks, Juan Vargas, Brian Higgins, Lucille Roybal-Allard, Jackie Speier, Mark Pocan, Pramila Jayapal, Alcee Hastings, Seth Moulton, Dina Titus, Norma Torres, James Himes, Bobby Rush, Julia Brownley, Dan Kildee, Adam Smith, James McGovern, John Garamendi, Joseph Kennedy, Nydia Velazquez, Doris Matsui, Mike Quigley, Tim Ryan, David Cicilline, Grace Napolitano, Bill Foster, Angie Craig, Shiela Jackson Lee, Debbie Wasserman Schultz, Scott Peters, Ilhan Omar, Jennifer Wexton, Peter DeFazio, Jerrold Nadler, Rose L. DeLauro, Susan Wild, Denny Heck, Debbie Watson Coleman, Barbara Lee, Jimmy Panetta, Robin L. Kelly, Anthony Brown. March 28, 2019: H.R.1981 – Prohibition of Medicaid Funding for Conversion Therapy Act was introduced in the U.S. House of Representatives. Here are some key points from the text of the bill: It is to amend title XIX of the Social Security Act to prohibit payments under the Medicaid program for conversion therapy.It adds a new paragraph to XIX of the Social Security Act: “provide that, beginning with the first day of the first quarter that begins on or after the date of enactment of this paragraph, no payment may be made under the plan with respect to conversion therapy (as defined in subsection (qq)) furnished to an individual enrolled under the plan (or a waiver of such plan).”The term ‘conversion therapy’ (A) means any practice or treatment by any person that seeks to change another individual’s sexual orientation or gender identity, including efforts to change behaviors or gender expressions, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender, if such person receives monetary compensation in exchange for any such practice or treatment; and(B) does not include any practice or treatment, which does not seek to change sexual orientation or gender identity, that – (i) provides assistance to an individual undergoing a gender transition; or (ii) provides acceptance, support, and understanding of a client or facilitation of client’s coping, social support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices.The term ‘gender identity’ means the gender-related identity; appearance, mannerisms, or other gender-related characteristics of an individual, regardless of the individual’s designated sex at birth.The term ‘person’ means any individual, partnership, corporation, association, or any other entity.The term ‘sexual orientation’ means homosexuality, heterosexuality, or bisexuality.” March 28, 2019: The Center for Reproductive Rights posted a press release titled: “Mississippi Six-Week Abortion Ban Challenged in Court”. From the press release: Today, the Center for Reproductive Rights expanded their current lawsuit in Mississippi, adding a challenge to the state’s six-week ban signed into law last week. The Center is asking a federal court to block the law before it takes effect on July 1, criminalizing abortion once a heartbeat has been detected – around six weeks of pregnancy. The law passed the Mississippi legislature with votes from 99 male legislators and only 11 women. The ban is even more restrictive than Mississippi’s 15-week ban, which a federal district court struck down just months ago……”Let’s call this law what it is – a near total ban on abortion,” said Nancy Northup, President & CEO of the Center for Reproductive Rights. “Many women don’t even know they’re pregnant at six weeks, and this law would force them to carry their pregnancies to term. Just four months ago, a federal judge told Mississippi they cannot ban abortion after 15 weeks, and now they’ve banned it even earlier. We will keep taking them to court until they get the message.”……In November, a federal district court in Mississippi struck down the state’s 15-week ban, determining that it “unequivocally” violated the Fourteenth Amendment guarantee of reproductive autonomy. In that decision, the court described the 15-week ban as “closer to the old Mississippi – the Mississippi bent on controlling women and minorities” and described the state’s “professed interest in women’s health” as “gaslighting.” The state continues to defend the 15-week ban on appeal.In addition to Mississippi, three other states have passed six-week bans – Kentucky (2019); Iowa (2018); and North Dakota (2013) – but all have been blocked by the courts. The Supreme Court recognized in Roe v. Wade and reaffirmed just two years ago that the states cannot deny women the ultimate decision to terminate a pregnancy prior to viability.Mississippi women already face a mountain of barriers to abortion, many of which the Center is also challenging. For example, women must receive biased counseling designed to deter them from having an abortion and then must wait 24 hours before returning to the clinic to obtain an abortion. Minors must get consent from both of their parents, or obtain a judicial bypass, before accessing abortion care. Doctors cannot use telemedicine to prescribe pills for medication abortion. Furthermore, the state’s Medicaid program does not cover abortion care, and state healthcare plans offered under the Affordable Care Act only cover abortion if the woman’s life is endangered, or in cases of rape or incest. The state also has a “trigger ban,” which would ban abortion immediately if Roe v. Wade is overturned… The Center for Reproductive Rights posted the preliminary injunction brief. March 29, 2019: Planned Parenthood posted a press release titled: “Administration Strips Planned Parenthood FY2019 Title X Funding in Obvious Move to Push Planned Parenthood Out of Program”. From the press release: The Trump-Pence Administration today announced that it’s stripping Title X funding from several qualified Planned Parenthood affiliates, despite their proven record of providing a high volume of people struggling to make ends meet with birth control, breast cancer and cervical cancer screenings, and STI testing and treatment. The administration’s fiscal year 2019 grants prove, yet again, that the administration will do anything it takes to limit Planned Parenthood’s ability to serve patients through Title X. These cuts to Planned Parenthood’s Title X funding come just after a report that the administration coached an ideologically friendly state health department on how to apply for funds, and only five weeks before Trump’s gage rule is set to take affect, which would put Planned Parenthood out of Title X altogether….…The four Planned Parenthood affiliates that were stripped of funding in Hawaii, North Carolina, Ohio, Wisconsin, and Virginia serve more than 40,000 patients (Planned Parenthood Southwest Ohio Region, Planned Parenthood of the Great Northwest and the Hawaiian Islands, Planned Parenthood South Atlantic, and Planned Parenthood of Wisconsin). For instance, Wisconsin serves an overwhelmingly majority of the patients in the state and has for nearly 50 years.In addition to the FY19 grants, the administration is using the gag rule as a tool to push Planned Parenthood out of Title X. It would block patients from care at Planned Parenthood and bar providers from referring patients for safe, legal abortion. The administration’s FY20 budget proposal includes a provision to stop Planned Parenthood from serving patients in Title X – even though Planned Parenthood health centers serve 41 percent of the 4 million patients who depend on Title X health centers.. The press release also includes a statement from Dr. Leana Wen, President, Planned Parenthood Federation of America: “This lates Trump-Pence administration’s attack on health care affects the ability of 40,000 patients to receive cancer screenings, birth control, STI tests, and other crucial primary and preventative health services. From the beginning, the administration has made it clear it wants to dismantle the Title X program by forcing out trusted health centers that provide evidence-based, comprehensive reproductive health care. Today, they are removing funding form these trusted health centers and providing funding to entities that do not provide evidence-based treatment. This continued attack on Title X will result in dismantling our nation’s program for affordable birth control and reproductive health care, risking access to comprehensive health care for millions of low-income women and families. Planned Parenthood will not let this stand. Just as we are fighting the Trump-Pence administration’s unethical, illegal, and harmful Title X gag rule, we will be fighting through every avenue to protect patients’ rights and every person’s ability to access health care.” March 29, 2019: Planned Parenthood posted a press release titled: “Georgia Third State This Year to Pass Six-Week Abortion Ban, Headed to Gov. Kemp.” From the press release: Politicians in Georgia passed this bill despite mass opposition to the ban. Support for Roe v Wade is at its highest level on record — 73% of Americans say they do not want to see Roe overturned. More than 300 Georgia business leaders spoke out publicly against the ban. The Georgia film and entertainment industry published letters, threatening to boycott work in Atlanta if the ban passes. Yet, the bill passed with little regard for the constituents these legislators claim to represent…Today, Georgia became the third state this year after Kentucky and Mississippi, to pass a ban on abortion before many people know they are pregnant. The bill passed by one vote. This is part of an alarming national trend of abortion bans. Just this week, Planned Parenthood and Guttmacher Institute released a 2019 State Abortion Restriction Snapshot that shows nearly half of abortion restrictions introduced in state legislatures are bans of one type or another — and in fact, there has been a 63% spike in six-week abortion bans, like the one in Georgia, compared to this time last year. Georgia is just one of 32 states to introduce abortion bans this year as part of a national strategy to outlaw safe, legal abortion.…The sustained and coordinated effort to ban abortion in states has also triggered a counter-movement of reproductive health champions who are introducing bills that would protect and expand abortion access. In more than half the states, champions are pushing for bills that codify abortion rights in to state law, repeal harmful policies that create barriers to care, and would treat abortion as health care, not a crime. New York was the first state this year to codify abortion rights into law. Other states like Illinois, Vermont, Massachusetts, Maine, and Rhode Island are aggressively pursuing similar laws. The press release included a statement by Dr. Leana Wen, President, Planned Parenthood Action Fund: “Georgia’s six-week ban is a dangerous policy designed to block abortion access before many women even know they’re pregnant. Almost weekly now, we are seeing bans on abortion care like this one. These restrictions go beyond rhetoric, they will only roll back gains to public health and harm women’s health and the health of families across Georgia. Planned Parenthood will not back down from this fight. Planned Parenthood’s patients in Georgia and across the country deserves the right to control their own body, life, and future, no matter where they live or how much money they make. As health care providers and advocates, everyone must work together with our elected champions to pass policies that will protect the right to safe, legal abortion. There are few options left and time is running out for women everywhere. With Kavanaugh on the Supreme Court and Trump in the White House, access is on the line.” March 29, 2019: Senator Diane Feinstein tweeted: “If Republicans successfully overturn the Affordable Care Act, California would lose $22.4 billion in federal funding that currently provides health care for vulnerable children and families. We must not let Republicans put millions of families in jeopardy.” March 31, 2019: Larry Levitt, Senior VP at Kaiser Family Foundation, tweeted: “The president’s budget on March 11 proposed replacing the ACA with an approach molded after the Graham-Cassidy bill, providing “relief” from “many” of the ACA’s insurance rules. The original Graham-Cassidy bill allowed unlimited premiums on people with pre-existing conditions.” March 31, 2019: Larry Levitt, Senior VP at Kaiser Family Foundation tweeted: “Now that we seem to be talking about pre-existing conditions again, a reminder of what it takes to truly protect people: Guaranteed access to insurance. A limit on premiums charged to sick people. Required benefits. A cap on out-of-pocket costs. No lifetime or annual limits.” April 1, 2019: The American Medical Association, posted a press release titled: “AMA, physician groups defend ACA gains in new Texas v. filing”. From the press release: In defense of significant coverage gains and key patient protection provisions of the Affordable Care Act (ACA), the American Medical Association (AMA) and other leading physician organizations today filed an amicus brief on the case of Texas v United States. Additional organizations joining the AMA include the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP) and the American Psychiatric Association (APA).“The district court ruling that the individual mandate is unconstitutional and inseparable from the remainder of the ACA would wreak havoc on the entire health care system, destabilize health insurance coverage, and roll back federal health policy to 2009,” said AMA President Barbara L. McAneny, M.D. “The ACA has dramatically boosted insurance coverage, and key provisions of the law enjoy widespread public support. The district court’s decision to invalidate the entire ACA should be reversed.”If the district court ruling is upheld, it would adversely impact every single American, rendering the following ACA provisions null and void: Patients would no longer have protections for pre-existing health conditionsChildren would no longer have coverage under their parents’ health plans until age 26Insurers would no longer be held to the 85% medical loss ratio, meaning they could generate higher profits at the expense of coverage and payments for services100 percent coverage for certain preventative services would ceaseIndividual marketplace and subsidies based on income would be eliminatedFederal funding for Medicaid expansion would end, as would Medicaid eligibility expansionAnnual and life-time dollar limits could be reinstated, leading to more bankruptcies due to health care costs…. April 1, 2019: Reuters posted an article titled: “Two Republican attorneys general urge court to uphold Obamacare”. It was written by Brendan Pierson. From the article: Two Republican state attorneys general on Monday urged a federal appeals court to uphold the Obamacare federal healthcare law, saying that striking it down would be disruptive for patients, doctors, insurers and employers.The attorneys general of Ohio and Montana submitted “friend of the court” briefs to the 5th U.S. Circuit Court of Appeals, which is expected to review a December ruling by U.S. District Judge Reed O’Connor in Fort Worth, Texas, striking down the Affordable Care Act, popularly known as Obamacare.Dozens of patient and healthcare industry groups, including the American Medical Association, American Hospital Association, American Cancer Society and seniors advocacy group AARP also filed briefs in support of the law.The briefs come less than a week after the U.S. Department of Justice, in an unexpected legal maneuver, said the entire healthcare law should be invalidated. Previously, President Donald Trump’s administration had said portions of Obamacare should be struck down and others should survive, including a state-led expansion of the Medicaid health insurance program for the poor… April 1, 2019: The AARP and AARP Foundation posted a press release titled: “AARP and AARP Foundation Submit Amicus Brief in Support of ACA and the Security It Provides Older Americans”. From the press release: AARP and AARP Foundation filed an amicus brief today with the United States Court of Appeals for the Fifth Circuit supporting the constitutionality of the Patient Protection and Affordable Care Act (ACA) and asking it to reverse the trial court’s December 2018 ruling in Texas v. United States. The brief argues that if the ACA is invalidated, millions of older Americans will be harmed, many will lose their health coverage, and the nation’s health system will be thrown into turmoil.“AARP vigorously opposes any attempt to dismantle the ACA, which will undoubtedly threaten the health and financial stability of millions of Americans, including older adults, that the law has provided for nearly a decade,” said Nancy LeaMond, AARP Executive Vice President and Chief Advocacy & Engagement Officer. “Undermining the ACA will increase out-of-pocket expenses for older Americans by reopening the Part D ‘doughnut hole’ and taking away key consumer protections, including preventing insurers from charging an age tax and guaranteeing coverage for people with preexisting health conditions.”According to the brief:“The ACA is a lifeline for millions of Americans, including older adults, who rely on it for their health and financial stability. More than nine years after its enactment, the ACA has become an integral part of the nation’s health care system. Among other things, it expands access to quality affordable care, guarantees coverage for people with preexisting conditions, and limits how much more insurers can charge older adults. It strengthens the financial viability of Medicare, lowers Medicare prescription drug costs, and expands Medicaid eligibility.”“If this Court find the ACA is invalid, millions of older adults will lose the health care coverage and consumer protections they have relied on for years. It will also throw the Medicare and Medicaid programs into fiscal and administrative chaos, which will disrupt the nation’s health care system and economy. It will plunge the more than 100 million people with preexisting conditions into an abyss of uncertainty about whether they can obtain coverage. Finally, it will destroy hard-fought gains, including protections for nursing facility residents and the lowest income seniors who rely on Medicare.”“When Congress reduced the tax penalty for not complying with the minimum coverage provision, it did not intend to dismantle the ACA. It also did not intend for that reduction to affect any other ACA provision, including those that protect people with preexisting conditions and limit age rating. Instead, Congress limited its actions in the Tax Cuts and Jobs Act of 2017 to reducing the tax penalty for not complying with the minimum coverage provision to $0.” The amicus brief includes AARP and AARP Foundation, Center for Medicare Advocacy, and Justice in Aging. April 1, 2019: Center for Medicare Advocacy posted a press release titled: “Center for Medicare Advocacy Files Amicus Brief in Support of the Affordable Care Act”. From the press release: Today the Center for Medicare Advocacy joined AARP and Justice in Aging in filing an amicus brief in Texas v. United States, urging the Fifth Circuit Court of Appeals to reverse the trial court’s December 2018 ruling that would nullify the entire Affordable Care Act (ACA). The three organizations highlight the ACA’s critical protections for older adults and the disastrous ramifications that would ensue if the law were to be struck down. The amicus brief was filed in support of the appellant states, which are led by California. Last week, the U.S. Department of Justice announced a new, more extreme position in the case, maintaining that the entire law must be invalidated.The brief explains that the ACA is a lifeline for older adults, who rely on it for their health and financial stability. For “pre-Medicare” individuals, age 50-64, the law guarantees coverage of preexisting conditions and limits how much more insurers can charge based on age. For Medicare beneficiaries, the ACA lowers medical costs by, among other things, closing the “doughnut hole” in the Medicare Part D prescription drug benefit. That provision alone has save more than 11.8 million Medicare beneficiaries over $26.8 billion. The law eliminated out-of-pocket costs for numerous preventative services. The ACA also helps nursing facility residents by protecting against fraud and abuse. Finally, the ACA strengthens the financial solvency of the Medicare program, having extended the life of the Medicare Trust Fund by approximately eight years.“If the ACA is struck down,” said Judith Stein, Executive Director for the Center for Medicare Advocacy, “millions of older adults and people with disabilities will lose the health care coverage and consumer protections they have relied on for almost a decade.” Because the ACA contains around 165 provisions that impact Medicare, it will also throw the Medicare program into fiscal and administrative turmoil, which will disrupt the nation’s health care system and economy. It will plunge more than 100 million people with preexisting conditions into uncertainty about whether they can obtain coverage.As the brief states:The ACA is deeply rooted into the nation’s health care system and economy. Millions of Americans depend on the ACT for their health, protection, and well-being. Their lives now hang in the balance… The ACA is the law of the land. April 1, 2019: The American Academy of Family Physicians (AAFP) posted news on their website titled: “AAFP Joins Objection to Administration’s Move Against ACA”. From the news: During the heated campaigning of last fall’s midterm elections, the White House and officials from both parties pledged that people with preexisting health conditions would not lose the safeguards afforded by the Patient Protection and Affordable Care Act (ACA).This month, the Academy and five peer medical organizations charged in a March 27 statement that the administration had broken that promise.The Group of Six spoke out in response to a March 25 letter from the Department of Justice (DOJ) to the U.S. Court of Appeals for the Fifth Circuit. In that two-sentence letter, the administration – which last year said it would cease defending the ACA in court – announced that it now plans to argue against the law.Referring to a judgement issued in December by U.S. District Judge Reed O’Connor in Texas et al. v. United States et. al., that the ACA has become unconstitutional, the letter read, in full: “The Department of Justice has determined that the district court’s judgement should be affirmed. Because the United States is not urging that any portion of the district court’s judgement should be reversed, the government intends to file a brief on the appellee’s schedule.”O’Connor’s ruling in the case, which was brought by 20 state attorneys general seeking to strike down the ACA, said the law became unconstitutional once Congress eliminated the tax penalty imposed on people who do not obtain health insurance — the ACA’s “individual mandate.”The AAFP voiced strong disagreement with that decision.This latest reversal, the Group of Six said in its statement, “would endanger not only essential protections for persons with preexisting conditions, but other programs that millions of Americans depend on to ensure their access to affordable health care.” Among these crucial items now in jeopardy: federal funding for Medicaid expansion, premium subsidies to make coverage affordable in the individual market, and the ACA’s ban on annual and lifetime coverage limits… April 1, 2019: Donald J. Trump tweeted: “Everybody agrees that ObamaCare doesn’t work. Premiums & deductibles are far too high – Really bad HealthCare! Even the Dems want to replace it, but with Medicare for All, which would cause 180 million Americans to lose their beloved private health insurance. The Republicans…” April 1, 2019: Donald J. Trump tweeted: “…are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare. In other words it will be far less expensive & much more usable than ObamaCare. Vote will be taken right after the Election when Republicans hold the Senate & win…” April 1, 2019: Donald J. Trump tweeted: “…back the House. It will be truly great HealthCare the will work for America. Also, Republicans will always support Pre-Existing Conditions. The Republican Party will be known as the Party of Great HealtCare. Meantime, the USA is doing better than ever & is respected again!” April 1, 2019: Senator Susan Collins (Republican – Maine) sent a letter to U.S. Attorney General William P. Barr regarding Texas v. United States. From the letter: I am writing to express my profound disagreement with the Department’s court filing on March 25, 2019, indicating that it will not defend any portion of the Affordable Care Act (ACA) in the ongoing litigation before the United States Court of Appeals for the Fifth Circuit. This surprising decision goes well beyond the position taken by the Department last June, and puts at risk not only critical consumer provisions such as those protecting individuals suffering from pre-existing conditions, but also other important provisions of that law, such as the Medicaid expansion, dependent coverage for young adults to age 26, coverage for preventative services, and the regulatory pathway for FDA approval of biosimilars.Last June, then-Attorney General Sessions argued that the ACA’s provisions protecting people with pre-existing conditions are inseparable from the individual mandate, and cannot survive if that provision is struck down as unconstitutional. In a letter to Attorney General Sessions at the time, which I will attach for your convenience, I noted my opposition to the individual mandate as the penalty for violating it was highly regressive. Nevertheless, I disagreed that eliminating this regressive penalty would require striking the ACA’s pre-existing conditions and other critical consumer protections. Now, however, the Department has gone even further by arguing that all remaining provisions of the ACA should be ruled invalid….…As I explained in my letter to Attorney General Sessions, sever ability shouldn’t be measured solely by Congress’s intent in 2010, when the Affordable Care Act became law, but rather by Congress’s intent in 2017, when Congress amended it through the Tax Cuts and Jobs Act. It is implausible that Congress intended protections for those with preexisting conditions to stand or fall together with the individual mandate, when Congress affirmatively eliminated the penalty while leaving these and other critical consumer protections in place. If Congress had intended to eliminate these consumer protections along with the individual mandate, it could have done so. It chose not to do so.Rather than seeking to have the courts invalidate the ACA, the proper route for the Administration to pursue would be to propose changes to the ACA or to once again seek its repeal. The Administration should not attempt to use the courts to bypass Congress.I continue to believe that the individual mandate should be treated as severable. The Administration should reconsider its decision and defend the remainder of the ACA. April 1, 2019: Senator Jeanne Shaheen (D-NH) posted a press release on her official website titled: “Shaheen Introduces Health Care Affordability Package to Lower Patient Costs & Improve Access to Care, Amid Renewed Republican Efforts to Repeal Health Coverage for Millions.” From the press release: …Today, U.S. Senator Jeanne Shaheen (D-NH) introduced a health care affordability package, which includes three pieces of legislation that would reduce health care costs for patients and expand access to critical medical services. Together, the Marketplace Certainty Act, Improving Health Insurance Affordability Act and Reducing Costs for Out-of-Network Services Act, would make essential reforms to the health care law that would help stabilize the marketplace, lower premiums for middle-class families and combat escalating out-of-pocket health care costs……Senator Shaheen’s health care affordability package will comprehensively address a number of concerns with the health care law to help deliver more accessible, affordable care to Granite Staters and Americans across the country.The Marketplace Certainty Act would reduce deductibles and co-pays for low-income and middle-income patients by expanding the cost-sharing reduction assistance that insurers are required to provide to individuals enrolled in marketplace coverage. In 2019, the existing cost-sharing reduction requirements helped reduce deductibles by thousands of dollars per year for millions of individuals and families. Senator Shaheen’s bill would expand eligibility for this cost-sharing reduction assistance to more patients and would increase the generosity of the deductible and co-pay relief provided by the cost-sharing reduction assistance. This bill would also permanently appropriate funding to restore the payments to insurers to reimburse them for the cost of providing the cost-sharing reduction assistance. These reimbursement payments were suspended by the Trump administration in October 2017. The suspension of the payments – part of the Trump administration’s continuing efforts to sabotage the Affordable Care Act (ACA) – has resulted in significant increases in premiums for individuals enrolled in health care plans under the ACA.The Improving Health Insurance Affordability Act increases the value of tax credits for families who are currently eligible for federal assistance, which helps offset the costs of monthly premiums, and expands eligibility for premium tax credits to include more middle-income families. In addition to making health care more affordable, a recent analysis suggests that these changes could grow enrollment in the Health Insurance Marketplaces by millions of consumers and reduce premiums for those currently enrolled in the coming years.The Reducing Costs for Out-of-Network Services Act would establish caps on how much hospitals and physicians could charge enrollees in the individual market for services provided by out-of-network medical providers, while also applying caps to hospital and physician charges for uninsured patients. A recent study projects that in 2019, 72 percent of enrollees on the Health Insurance Marketplaces are enrolled in plans with restrictive networks that often have limited or not coverage for services furnished by out-of-network medical providers. Out-of-network charge caps that are similar to those proposed in Senator Shaheen’s legislation are already in place in the Medicare Advantage program. These charge caps have proven effective in reducing Medicare beneficiaries’ out-of-pocket costs, and can help them reduce health plans’ costs for in-network provider services – which in turn can help reduce premiums… April 1, 2019: The Tampa Bay Times posted an editorial titled: “Why the Affordable Care Act should be saved, not killed.” From the editorial: The Affordable Care Act has been the law of the land for nine years and touches the lives of nearly every American. It ensures no one can be denied coverage because of a pre-existing condition. It also ensures no one can be bankrupted by medical bills, because it bans lifetime limits on insurance coverage. The law has saved countless lives, and it is supported by far more Americans than oppose it. Yet the Trump administration has irresponsibly announced it wants to overturn the entire law by agreeing with a Texas judge who ruled that it is unconstitutional. Never mind that neither the president nor congressional Republicans have an alternative ready to replace the Affordable Care Act. The case is now before a federal appeals court. Here’s a reminder of 15 facts and what is at stake:21 million Americans could lose their health insurance if the Affordable Care Act is overturned.102 million Americans have a pre-existing medical condition that could raise their premiums or deny them coverage altogether if they sought insurance without the protection of the Affordable Care Act, according to a study by Avalere, a health care consulting firm. That’s half of Americans enrolled in coverage outside Medicare or Medicaid.About 8 million Floridians have pre-existing conditions, including 2.1 million Floridians who have individual coverage.1.8 million Floridians signed up for health insurance in the federal exchange under the Affordable Care Act for 2019.#1 Florida’s rank among the 39 states that use the federal health care exchange.Florida is one of the states that are plaintiffs in the Texas lawsuit where the federal judge ruled the Affordable Care Act is unconstitutional.55% of American voters support improving, not replacing, the nation’s health care system, according to a Quinnipiac poll released last week… April 1, 2019: Gallup posted information titled: “Healthcare Once Again Tops List of Americans’ Worries”. From the information: Fifty-five percent of Americans worry “a great deal” about the availability and affordability of healthcare, topping Gallup’s list of potentially worrisome issues for the fifth straight year. A majority of Americans have said they worry a great deal about healthcare in each of the 18 years the question has been asked since 2001, more than twice as often as any of the other 12 issues most often measured……The consistency of concern about healthcare stands in contrast to the other economic issues that dominated Gallup’s list of worries in 2010 and 2011, as the nation began its climb out of the 2008-2009 Great Recession……Meanwhile, the percentage worrying a great deal about the availability and affordability of healthcare has held steady. It is within one point of where it was in 2010 (56%) and has never dropped below 54% over the past nine years. In October, Americans said healthcare was one of their top issues for the midterm elections, and in November, 61% said the possibility of increases in healthcare insurance costs was “a major concern.”.. April 2, 2016: Senator Jeanne Shaheen (D-New Hampshire) posted a press release on her official website titled: “Responding to Trump Administration’s Effort to Strike Down ACA, Shaheen Leads Resolution to Save Pre-Existing Condition Protections & Health Care For Millions”. From the press release: …U.S. Senator Jeanne Shaheen (D-NH) led all 47 Senate Democrats today on a Senate resolution that would revers the Department of Justice’s (DOJ) recent decision to side with U.S. District Court Judge Reed O’Connor’s ruling that deems health care protections enjoyed by millions of Americans unconstitutional.This latest act of health care sabotage from the Trump administration could result in 133 million Americans losing protections for pre-existing conditions, millions more Americans without health insurance, soaring prescription drug spending for seniors, and as many as 118,000 Granite Staters losing health coverage. After Congressional Republicans zeroed out the tax for failure to meet the ACA’s health insurance coverage requirement in their partisan tax legislation, the State of Texas challenged the constitutionality of the entire Affordable Care Act as unconstitutional.The resolution introduced by Shaheen and cosponsored by all 47 Senate Democrats outlines the dire consequences of this politically-motivated action for hard-working American families and proclaims the DOJ’s decision must be reversed……Congressman Colin Allred (D-TX) introduced a similar resolution in the House of Representatives, which will be considered today.Shaheen’s resolution comes on the heels of her health care affordability package, which she announced yesterday… April 2, 2019: The Hill posted an article titled: “McConnell to Trump: We’re not repealing and replacing ObamaCare”. It was written by Alexander Bolton. From the article: Senate Majority Leader Mitch McConnell (R-Ky.) told President Trump in a conversation Monday that the Senate will not be moving comprehensive health care legislation before the 2020 election, despite the president asking Senate Republicans to do that in a meeting last week.McConnell said he made it clear to the president that Senate Republicans will work on bills to keep down the cost of health care, but that they will not work on a comprehensive package to replace the Affordable Care Act, which the Trump administration is trying to strike down in court……After getting the message from McConnell, Trump tweeted Monday night that he no longer expected Congress to pass legislation to replace ObamaCare and still protect people with pre-existing medical conditions, the herculean task he laid before Senate Republicans at a lunch meeting last week……Trump blindsided GOP senators when he told them at last week’s lunch meeting that he wanted Republicans to craft legislation to replace the 2010 Affordable Care Act.The only heads-up they got was a tweet from Trump shortly before the meeting saying, “The Republican Party will become The Party of Healthcare!”… April 2, 2019: The Hill posted an article titled: “Democrats rally at Supreme Court ahead of ObamaCare vote”. It was written by Jessie Hellmann. From the article: House and Senate Democrats rallied on the steps of the Supreme Court Tuesday ahead of a vote on a resolution asking the Department of Justice (DOJ) to reverse its decision to side with a lower court ruling ObamaCare unconstitutional.The symbolic resolution will likely pass the Democratic-controlled House Wednesday, but it won’t get a vote in the Senate, where Republicans are in the majority. But it gives Democrats another chance to highlight the Trump administration’s efforts to repeal ObamaCare, which they see as a winning issue ahead of the 2020 elections… April 2, 2019: The Speaker of the House website posted news titled: “Pelosi Remarks at Press Event on Supreme Court Steps Calling on Trump Administration to Halt Assault on American’s Health Care in the Courts”. From the news: Speaker Nancy Pelosi joined House and Senate Democrats on the steps of the Supreme Court for a press event to highlight House and Senate resolutions and calling on the Trump Administration to halt its assault on Americans’ health care in the courts. Below are the Speaker’s remarks:…We are here to condemn what the President did. Last week, the Trump Administration radically expanded its war on the Affordable Care Act – on America’s health care – asking the court to strike down every last provision of the ACA.The distinguished Leader went through some of the concerns. Some bear repeating.Imagine that he would say, after the Republicans misrepresented their position on pre-existing conditions – remember during the campaign they said, ‘Oh we’re for the benefit of not having pre-existing conditions be a barrier to your access to health care’. They said that, in spite of the fact that over and over again they have voted to eliminate that benefit.And now, the President is acting in a way to not only eliminate that benefit, which is so important, also to eliminate a companion benefit that goes with the pre-existing condition – to eliminate the ban on lifetime limits and annual limits on people who need health care. This is terrible.Being a woman is no longer a pre-existing condition under the ACA. You can be on your parent’s policy. Lengthening the stability and solvency of Medicare – they don’t care. They think Medicare should wither on the vine. That is the Republican mantra.When Medicare was passed, they said it would lead to a socialist dictatorship. They do not believe in a public role. They are anti-governance.So, this is not an issues fight or a legislative fight; it’s a values fight for our country. That we value the health and well-being of the American people and we recognize that their financial stability is related to their health stability.The Medicaid expansion, as the distinguished Leader said, this isn’t just about the 20 million people who now have access to quality, affordable, health care. It’s about over 150 million American families who have better care, better benefits. Again, no lifetime limits, no pre-existing conditions ban and some of the other provisions that I mentioned.Better benefits, lowering the increase in costs, improving the health – not just the health care, but the good health of Americans. It’s about prevention. It’s about nutrition.Its about so many things that perhaps they don’t understand, but what we do understand is that they do not believe in public policy that affects the good health of the American people. And that is why we’re going to have this resolution debated on the floor today, voted tomorrow. From day one, Congressman Colin Allred led the way. House Democrats voted to throw the full legal weight of the Democrats in the House of Representatives and we hope that some of the Republicans will join us against the Texas lawsuit, he’s from Texas.But more than 190 Republicans voted to be fully complicit in everything this monstrous proposal puts forth.So, because of the President’s actions, which are to be condemned, that lawsuit is even more dangerous than it was in January, and that is why we are bringing forth that Allred resolution this week.The American people deserve to know exactly where their representatives stand on the Trump Administration’s vicious campaign to take way their health care. This is so interesting because the President has been trying to do away with the Affordable Care Act from day one. We know that. And the way it was protected was not just by our inside maneuvering, it was because of the outside mobilization of so many groups. Many of whom are present today… April 2, 2019: Speaker Nancy Pelosi tweeted: “During the 2019 election, Republicans claimed they supported protections for Americans with pre-existing conditions. Their support for Texas v U.S. – which would destroy protections for people w/ pre-existing conditions – is yet another sign of their true colors. #ProtectOurCare” April 2, 2019: Speaker Nancy Pelosi tweeted: “The American people deserve to know “exactly” where their representatives stand on the Trump Admin’s vicious attacks on American’s health care. #ProtectOurCare”. April 2, 2019: Senator Chuck Schumer tweeted: “We know what the GOP health plan would look like: gut protections for pre-existing conditions & massive losses of coverage. Today, Senate & House Democrats introduced resolutions telling the Trump DOJ to reverse its position to take away coverage for nearly 20 million Americans.” The tweet includes a photo of Senator Chuck Schumer standing a a podium in front of the Supreme Court. The podium has a sign that says #ProtectOurCare. He is surrounded by other Democrats. April 2, 2019: PBS News Hour posted an article titled: “House GOP tries to force vote about infants surviving attempted abortions”. It was written by Alan Fram. From the article: Republicans started a long-shot drive Tuesday to force a House vote on a measure that could imprison doctors for five years if they don’t try saving the life of infants born during attempted abortions.Their effort seems likely to fail in the Democratic-controlled House, where Speaker Nancy Pelosi, D-Calif., has refused to allow a vote on the bill. But Republicans hope it will be politically damaging for Democrats from moderate districts who oppose the GOP move, and see it as a way to energize conservative anti-abortion voters……Opponents say such births are extremely rare, generally occurring when doctors determine that a child won’t survive and parents opt to spend time with it before death.Republicans have been pushing the issue since it arose earlier this year in Virginia and New York….…House Republicans are utilizing a seldom used procedure that forces a vote on a measure once 218 lawmakers, a majority, sign a petition. Aides say all 197 Republicans are expected to sign. A few Democrats will probably join, but not the 21 Democrats that Republican will need to succeed.Senate Democrats blocked a GOP effort in February to force debate on a similar bill. April 2, 2019: Planned Parenthood posted a press release titled: “Planned Parenthood Condemns GOP House Petition to Criminalize Doctors”. From the press release: Today, Reps. Scalise (R-LA) and Wagner (R-MO) tried to force a vote on an act to criminalize doctors – the same bill which failed in the Senate in February. This bill is not based in science or reality, but is yet another part of the Trump-Pence administration and Republican leadership’s attacks on health care. This legislation is overwhelmingly opposed by the medical community. Politicians in Congress are trying to shame patients and criminalize doctors for a practice that doesn’t exist – while giving political cover to politicians at the state level to pass bans that outlaw abortion before many women know they’re pregnant. In fact, new data shows proposed six-week abortion bans – like the ban passed in Georgia last week – have increased an alarming 63 percent compared to last year……BackgroundThe claims regarding this legislation are completely false and offensive, and are not based in science or medicine. It’s important to remember that the people spreading this misinformation have one motive in mind — to ban safe, legal abortion in this country. About one in four women in this country will have an abortion in her lifetime. Undermining access to safe, legal abortion is widely out of touch with the majority of Americans – 73 percent of Americans do not want women to lose their access to safe, legal abortion.This bill represents overreach into the practice of medicine, and is opposed by medical groups. The American Congress of Obstetricians and Gynecologists strongly opposed this legislation calling it a “gross interference in the practice of medicine”. States across the country are chipping away at the ability to access abortion safely and legally. More than 420 abortion restrictions have gone into effect since 2011 – the constitutional right to safe, legal abortion in our country has been eroded to the point that millions of women across the US do not have access to abortion. April 3, 2019: The U.S. House of Representatives voted on H.Res.271 “Condemning the Trump Administration’s Legal Campaign to Take Away Americans’ Health Care”. H.Res 271 was sponsored by Colin Z. Allred, (D-Texas). It had 104 co-sponsors: Tom O’Halleran (D-Arizona)Donald Norcross (D-New Jersey)Joaquin Castro (D-Texas)Debbie Dingell (D-Michigan)Henry C. “Hank” Johnson Jr. (D-Georgia)Robin L. Kelly (D-Illinois)Adriano Espaillat (D-New York)Alan Lowenthal (D-California)Donna E. Shalala (D-Florida)Gilbert Ray Cisneros Jr. (D-California)Debbie Wasserman Schultz (D-Florida)Jim Cooper (D-Tennessee)Diana DeGette (D-Colorado)Katie Porter (D-California)Abigail Davis Spanberger (D-Virginia)John B. Larson (D-Connecticut)Steven Horsford (D-Nevada)Gerald E. Connolly (D-Virginia)Terri A. Sewell (D-Alabama)Mark Takano (D-California)Bonnie Coleman Watson (D-New Jersey)Jimmy Panetta (D-California)Jerrold Nadler (D-New York)Eleanor Holmes Norton (D-DC At Large)Donald A. McEachin (D-Virginia)David Cicilline (D-Rhode Island)Ted Lieu (D-California)Barbara Lee (D-California)Bobby L. Rush (D-Illinois)Michael F. Doyle (D-Pennsylvania)Bradley Scott Schneider (D-Illinois)Darren Soto (D-Florida)Paul Tonko (D-New York)David E. Price (D-North Carolina)Rosa L. DeLauro (D-Connecticut)Janice Schakowsky (D-Illinois)Adam Schiff (D-California)Tony Cardenas (D-California)Chris Pappas (D-New Hampshire)Norma J. Torres (D-California)Katherine M. Clark (D-Massachusetts)Filemon Vela (D-Texas)Angie Craig (D-Texas)Ruben Gallego (D-Arizona)Kathy Castor (D-Florida)David J. Trone (D-Maryland)Gwen Moore (D-Wisconsin)Gregorio Killi Cammacho Sabian (D-MP- At Large)Suzanne Bonamici (D-Oregon)Doris Matsui (D-California)Salud O. Carbajal (D-California)TJ Cox (D-California)Jefferson Van Drew (D-New Jersey)Anthony G. Brown (D-Maryland)Pramila Jayapal (D-Washington)Abby Finkenauer (D-Iowa)Marcy Kaptur (D-Ohio)Andy Kim (D-New Jersey)Brian Higgins (D-New York)Lori Trahan (D-Massachusetts)Peter A. DeFazio (D-Oregon)Linda T. Sanchez (D-California)Mikie Sherrill (D-New Jersey)Albio Sires (D-New Jersey)Bill Foster (D- Illinois)Jamie Raskin (D-Maryland)Steve Cohen (D-Tennessee)Cheri Bustos (D-Illinois)Eddie Bernice Johnson (D-Texas)Jennifer Wexton (D-Virginia)Thomas R. Suozzi (D-New York)Jim Costa (D-California)Joe Neguse (D-Colorado)Mary Gay Scanlon (D-Pennsylvania)Matt Cartright (D-Pennsylvania)Andy Levin (D-Michigan)Sylvia R. Garcia (D-Texas)Lizzie Fletcher (D-Texas)Brendan F. Boyle (D-Pennsylvania)Raja Krishnamoothi (D-Illinois)Greg Stanton (D-Arizona)William R. Keating (D-Massachusetts)Jimmy Gomez (D-California)Susan Wild (D-Pennsylvania)Jahana Hayes (D-Connecticut)Lisa Blunt Rochester (D- Delaware AtLarge)Bill Pascrell Jr. (D-New Jersey)Kim Schrier (D-Washington)John Garamendi (D-California)Dina Titus (D-Nevada)Eliot L. Engel (D-New York)Joyce Beatty (D-Ohio)Jerry McNerney (D-California)John A. Yarmuth (D-Kentucky)Karen Bass (D-California)James R. Langevin (D-Rhode Island)Julia Brownley (D-California)Madeline Dean (D-Pennsylvania)Al Lawson Jr. (D-Florida)Kendra S. Horn (D-Oklahoma)Rashida Tlaib (D-Michigan) The text of H.Res 271 is relatively short. Condemning the Trump Administration’s Legal Campaign to Take Away Americans’ Health Care.Whereas on February 26, 2018, 18 State attorneys and 2 Governors filed a lawsuit in the United States District Court for the Northern District of Texas, Texas v. United States … (in this preamble referred to as “Texas v. United States), arguing that the requirement of the Patient Protection and Affordable Health Care Act… (in this preamble referred to as “ACA”) to maintain minimum essential coverage is unconstitutional and, as a result, the court should invalidate the law.Whereas in a June 7, 2018, letter to Congress, then Attorney General Jefferson Davis Sessions announced that the Department of Justice – (1) would not defend the constitutionality of the minimum essential coverage provision; and(2) would argue that provisions protecting individuals with pre-existing conditions (specifically the provisions commonly known as “community rating” and “guaranteed issue”) are inseparable from the minimum essential coverage provision and should be invalidated;Whereas in the June 7, 2018, letter to Congress, Attorney General Sessions also advised Congress that “the Department will continue to argue that Section 5000A(a) is severable from the remaining provisions of the ACA”, indicating a difference from plaintiffs’ position in Texas v. United States;Whereas on December 14, 2018, the United States District Court for the Northern District of Texas issued an order that declared the requirement to maintain minimum essential coverage unconstitutional and struck down the ACA in its entirety, including protections for individuals with pre-existing conditions;Whereas the decision of the United States District Court for the Northern District of Texas was stayed and is pending appeal before the United States Court of Appeals for the Fifth Circuit;Whereas on March, 25, 2019, the Department of Justice, in a letter to the United States Court of Appeals for the Fifth Circuit, changed its position and announced that the entire ruling of the United States District Court for the Northern District of Texas should be upheld and the entire ACA should be declared unconstitutional;Whereas prior to 2014, individuals with pre-existing conditions were routinely denied health insurance coverage, subject to coverage exclusions, charged unaffordable premium rates, exposed to unaffordable out-of-pocket costs, and subject to lifetime and annual limits on health insurance coverage;Whereas as many as 133,000,000 nonelderly people in the United States –(1) have a pre-existing condition and could have been denied coverage, only offered coverage at an exorbitant price had they needed individual market health insurance prior to 2014, or had coverage for their pre-existing condition excluded prior to 2014; and(2) will lose protections for pre-existing conditions if the ruling of the United States District Court for the Northern District of Texas is upheld in Texas v. United States;Whereas contrary to President Trump’s public claims that he supports protections for people with pre-existing conditions, he has ordered his Department of Justice to actively pursue the destruction of these protections in Federal court;Whereas employer-provided health plans cannot place lifetime or annual limits on health coverage, and if the Trump Administration succeeds in its argument before court, more than 100,000,000 people in the United States who receive health insurance through their employer could once again face lifetime annual coverage limits;Whereas if the Trump Administration succeeds in its argument before the court, insurers would be allowed to impose an unlimited “age tax” on the health insurance premiums of older Americans;Whereas prior to 2010, Medicare enrollees faced massive out-of-pocket prescription drug costs once they reached a certain threshold known as the Medicare “donut hole”, and since the donut hole began closing in 2010, millions of Medicare beneficiaries have saved billions of dollars on prescription drugs;Whereas at a time when 3 in 10 adults report not taking prescribed medicines because of the cost, if the Trump Administration succeeds in its argument before the court, seniors enrolled in Medicare would face billions of dollars in new prescription drug costs;Whereas as of March 2019, 37 States, including the District of Columbia, have expanded or are in the process of expanding Medicaid to individuals with incomes up to 138 percent of the Federal poverty level, providing health coverage for more than 12,000,000 newly eligible people;Whereas if the Trump Administration succeeds in its argument before the court, the millions of individuals and families who receive coverage from Medicaid could lose eligibility and no longer have access to health care;Whereas as of March 2019, many people who buy individual health insurance are provided tax credits to reduce the cost of premiums and assistance to reduce out-of-pocket costs such as copays and deductibles, which has made individual health insurance coverage affordable for millions of people in the United States for the first time;Whereas if the Trump Administration succeeds in its argument before the court, the health insurance individual exchanges would be eliminated and millions of people in the United States who buy health insurance on the individual marketplaces could lose coverage and would see premium expenses for individual health insurance increase exorbitantly;Whereas if the Trump Administration succeeds in its argument before the court, people in the United States would lose numerous consumer protections in their coverage, including the requirements that – (1) plans offer preventative care without cost-sharing;(2) young adults have the option to remain on a parent’s plan until age 26; and(3) many health insurance plans offer a comprehensive set of essential benefits such as maternity care, addiction treatment, and prescription drug coverage;Whereas pursuant to section 516 of title 28, United States Code, the conduct of litigation in which the United States is a party is reserved to the Department of Justice;Whereas public report suggests that the President and his political advisors directed this course of action in direct contravention of the Department of Justice’s longstanding policy to defend Acts of Congress and duty to advance reasonable analysis of legal questions, for example –(1) when the Department of Justice changed its litigating position on June 7, 2018, in the Texas v. United States case to ask the court to strike down the ACA’s guaranteed issue and community rating requirements, thereby eliminating protections for people with pre-existing conditions and reinstating legal discrimination based on health status, that position was found to be so legally indefensible that three of the four career attorneys representing the Government refused to sign the relevant briefs and removed themselves from the case; and(2) when the Department of Justice changed its litigating position on March 25, 2019, in the appeal of Texas v. United States to seek the invalidation of every provision of the ACA, it was reported that the decision was made over objections of both the Department of Justice as well as the Department of Health and Human Services; andWhereas the Trump Administration has proceeded in the Texas v. United States lawsuit with total disregard for the consequences of its actions for the lives of millions of Americans; Now, therefore, be it.Resolved, That it is the sense of the House of Representatives that –(1) the actions taken by the Trump Administration seeking the invalidation of the ACA’s protections for people with pre-existing conditions, and later the invalidation of the entire ACA, are an unacceptable assault on the health care of the American people; and(2) the Department of Justice should –(A) protect individuals with pre-existing conditions, seniors struggling with high prescription drug costs, and the millions of people in the United States who newly gained health insurance coverage since 2014;(B) cease any and all effort to destroy Americans’ access to affordable health care; and(C) reverse its position in Texas v. United States, No 19-10011 (5th Cir.). The vote on H.Res 271 was 240 YEAS to 186 NAYS (and with one person voting “Present” and five people not voting). 232 Democrats voted YEA. 8 Republicans voted YEA. They were: Brian Fitzpatrick (R-Pennsylvania)John Katko, (R-New York)Tom Reed (R- New York)Denver Riggleman (R-Virginia)Chris Smith (R-New Jersey)Pete Stauber (R-Minnesota)Elise Stefanik (R-New York)Fred Upton (R- Michigan) 185 Republicans voted NAY. 1 Democrat voted NAY – Collin Peterson (D-Minnesota) Representative Anthony Gonzales (R – Ohio) voted “Present”. 5 Representatives did not vote at all: Donald McEachin (D-Virginia)Tom Rooney (R-Florida)John Rutherford (R-Florida)Tim Ryan (D-Ohio)Steve Stivers (R-Ohio) April 3, 2019: CNBC posted an article titled: “House condemns Trump’s support for tossing out Obamacare as Democrats put 2020 pressure on GOP”. It was written by Jacob Pramuk. From the article: The Democratic-held House voted Wednesday to condemn the Trump administration’s support for a lawsuit that aims to toss out the Affordable Care Act.The resolution will have little practical effect and likely will not get a vote in the GOP-held Senate. But by approving the measure, Democrats aim to put pressure on House Republicans ahead of a 2020 election that the party again wants to frame as a referendum on GOP attempts to scrap the health-care law.It passed the House by a 240-186-1 vote, as one Republican member voted “present”. Eight GOP lawmakers – many of whom could face tough reelection bids next year – supported the measure. Only one Democrat – Rep. Collin Peterson, an Obamacare skeptic whose Minnesota district overwhelmingly backed President Donald Trump in 2016 – voted against the resolution… April 3, 2019: Donald J. Trump tweeted: “I was never planning a vote prior to the 2020 Election on the wonderful HealthCare package that some very talented people are now developing for me & the Republican Party. It will be on full display during the Election as a much better & less expensive alternative to ObamaCare…” April 3, 2019: Donald J, Trump tweeted: “…This will be a great campaign issue. I never asked Mitch McConnell for a vote before the Election as has been incorrectly reported (as usual) in the @nytimes, but only after the Election when we take back the House, Etc. Republicans will always support pre-existing conditions! April 3, 2019: NYTimes Communications tweeted: “We stand by our reporting: nytimes.com/2019/04/02/us/… President Trump’s own budget includes his health care proposal:” The tweet included a link to a New York Times article from March 11, 2019. (Scroll back for more details on the article.) April 3, 2019: Action News 2 WBAY posted an article titled: “UPDATE: Federal court lets Wisconsin out of both ‘Obamacare’ lawsuits”. From the article: A federal judge has granted Wisconsin’s request to withdraw from a multi-state lawsuit seeking repeal of the federal health care law popularly known as Obamacare.The judge on Tuesday granted the request made by Democratic Attorney General Josh Kaul at the order of Democratic Gov. Tony Evers.The judge also allows Wisconsin to withdraw in a second case also related to the health care law on sex discrimination…. April 3, 2019: CBS News posted an article titled: “Georgia “heartbeat” abortion bill could join the legal fight to overturn Roe v. Wade”. It was written by Kate Smith. From the article: Gov. Brian Kemp is poised to sign the Georgia “heartbeat” abortion bill, one of the most restrictive pieces of anti-abortion access legislation in the country. But the bill could have implications beyond the state and ultimately affect women nationwide by providing legal bait to challenge Roe v. Wade.If approved, the bill will prohibit abortions after a heartbeat is detected – typically five to six weeks in a woman’s pregnancy, when most women don’t know they’re pregnant.The controversial bill, however, has little chance of being successfully implemented in the state. Similar legislation across the country has been temporarily blocked or struck down by federal judges who say they violate Roe v. Wade – the 1973 Supreme Court decision that guarantees a woman’s right to abortion up until a fetus is viable. The American Civil Liberties Union in conjunction with the Center for Reproductive Rights have promised to file a lawsuit against the Georgia law the moment it’s signed into law.But Elizabeth Nash, a senior state issues manager at the Guttmacher Institute in Washington, D.C. said the goal of the bill probably isn’t Georgia anyway. It’s Washington.“The whole point of this is that it’s aimed at the U.S. Supreme Court,” she said. “It could have a much bigger impact because it would impact access across the country.”In this regard, the bill isn’t unique. States have started introducing and passing more anti-abortion access legislation than ever before, hoping it may lead to the Supreme Court reconsidering Roe v. Wade, Nash said in a telephone interview with CBS News on Tuesday. States see an opportunity for a possible challenge to the 1973 ruling with the arrival of Justice Brett Kavanaugh….…If Governor Kemp signs Georgia’s six-week abortion ban, the legislation won’t go into effect until January 2020… April 8, 2019: The Trump administration filed a motion to expedite oral argument to the United States District Court for the Northern District of Texas. From the motion: Plaintiffs-Appellees are: State of Texas; State of Wisconsin; State of Alabama; State of Arizona; State of Florida; State of Georgia; State of Indiana; State of Kansas; State of Louisiana; State of Mississippi, by and through Governor Phil Bryant; State of Missouri; State of Nebraska; State of North Dakota; State of South Carolina; State of South Dakota; State of Tennessee; State of Utah; State of West Virginia; State of Arkansas; Neill Hurley; John Nantz Defendants-Appellants are: United States of America; United States Department of Health & Human Services; Alex Azar, II, Secretary of U.S. Department of Health and Human Services; United States Department of Internal Revenue; Charles P. Rettig, in his Official Capacity as Commissioner of Internal Revenue Intervenor Defendants-Appellants are: State of California, State of Connecticut; District of Columbia; State of Delaware; State of Hawaii; State of Illinois; State of Kentucky; State of Massachusetts; State of New Jersey; State of New York; State of North Carolina; State of Oregon; State of Rhode Island; State of Vermont; State of Virginia; State of Washington; State of Minnesota The Motion to Expedite Oral Argument says: The United States hereby moves to expedite the oral argument and, in particular, respectfully requests that the Court schedule oral argument during its scheduled sitting in July 2019. This motion is unopposed.In this case, plaintiffs challenge the constitutionality of the requirement, contained in the Patient Protection and Affordable Care Act, that certain individuals purchase health insurance. Plaintiffs further argue that the mandate is not severable from the remainder of the Act. A group of States have intervened to defend the constitutionality of the statute and to urge that even if the individual mandate is unconstitutional, it is severable from the rest of the Act. The House of Representatives has also intervened on appeal, and agrees that the individual mandate is constitutional and is severable regardless.In district court, the United States took the position that the mandate is unconstitutional and that it is not severable from the so-called guaranteed-issue and community-rating provisions of the Act, but that the remaining provisions of the Act are severable. After further consideration, the United States has informed this Court of its new position that it agrees with the district court that the mandate is unconstitutional and not severable with the remained of the Act, and that it therefore intends to file a brief on the appellee’s schedule.The opening briefs for the intervenor appellants were filed on March 25, 2019. Appellees’ brief and the brief for the United States are due on March 1, 2019.The United States respectfully requests that the case be calendared for oral argument in the sitting scheduled for the week of July 8. Prompt resolution of this case will help reduce uncertainty in the healthcare sector, and other areas affected by the Affordable Care Act. The importance of doing so is underscored by the change in the alignment of the parties on appeal. We are not asking the Court to shorten the period for the filing of reply briefs, which would be due under the rules on May 22, 2019.We have conferred with counsel for the other parties. The House consents to the relief requested by this motion: expedited scheduling of oral argument in the case for the Court’s regularly scheduled argument session in July 2019. The intervenor states and the plaintiff do not oppose this motion. Things to Know: The House of Representatives referred to in the motion was in the 115th Congress, when the Republicans had the majority the House. This case predates the beginning of the 116th Congress, where the Democrats have the majority in the House. This motion was made after the U.S. Department of Justice announced that it would not defend the Affordable Care Act.The United States District Court for the Northern District of Texas has two choices: it can approve the motion, or it can deny the motion. April 8, 2019: Senator Tammy Baldwin (Democrat – Wisconsin) posted a press release on her official website titled: “U.S. Senator Tammy Baldwin Helps Introduce Public Option for Affordable Care Act”. From the press release: As the Department of Justice refuses to defend the law that has extended quality health insurance coverage to over 20 million Americans, U.S. Senator Tammy Baldwin (D-WI), a member of the Senate Health, Education, Labor and Pensions Committee, helped introduced the Consumer Health Options and Insurance Competition Enhancement (CHOICE) Act. This legislation would add a publicly operated health insurance option to the Affordable Care Act’s individual marketplaces……The legislation was introduced by Senators Sheldon Whitehouse (D-RI) and Sherrod Brown (D-OH.) Congresswoman Jan Schakowsky (D-II) introduced companion legislation in the House of Representatives……The Affordable Care Act set up health insurance marketplaces to make it easier for consumers to shop for health insurance and to drive insurers to compete on the price and quality of their plans. The marketplaces have been extremely effective in helping to expand coverage. While the rate of uninsured Americans has fallen significantly since 2010, it is currently at a four-year high as a result of the Trump administration’s efforts to sabotage the law. One way to combat the rising uninsured rate is to stimulate competition to drive down prices, especially in areas of the country with few insurers.The CHOICE Act would create a public option subject to the same requirements that apply to other plans offered on Obamacare exchanges. It would offer the same premium tax credits and cost-sharing reductions to individual marketplace consumers.The Trump administration filed a brief in the U.S. Court of Appeals for the 5th Circuit last week calling for the federal courts to overturn the Affordable Care Act in its entirety. This week, Senator Baldwin and all 47 Senate Democrats introduced a Senate resolution that calls on the Trump administration to reverse its position on repealing the entire Affordable Care Act.Earlier this year, Senator Baldwin introduced the Medicare at 50 Act to give people between the ages of 50 and 64 years old the option of buying into Medicare. Baldwin also helped reintroduce the State Public Option Act that would create a Medicaid-based public health care option to strengthen the Affordable Care Act by providing Americans with a new high-quality, low-cost choice when purchasing health insurance. April 9, 2019: Representative Jerrold Nadler (Democrat – New York) posted a press release on his official website titled: “House Chairs Seek Documents from Trump Administration on Sudden Decision to Stop Defending Health Care Law”. From the press release: Five House Committee Chairs sent letters to the Department of Justice (DOJ), the Department of Health and Human Services (HHS), and the White House requesting documents and information regarding the involvement of White House officials in the Administration’s troubling decision to not defend the constitutionality of the Affordable Care Act (ACA).The letters were signed by Committee on Oversight and Reform Chairman Elijah E. Cummings, Committee on Energy and Commerce Chairman Frank Pallone, Jr., Committee on Ways and Means Chairman Richard E. Neal, Committee on Education and Labor Chairman Bobby Scott, and Committee on the Judiciary Chairman Jerrold Nadler.The chairs wrote in their letter to HHS and the White House:“If the Administration’s new legal position prevails and the entire ACA is struck down, there would be catastrophic implications for millions of American consumers and the United States health care system.”The chairs wrote in their letter to the DOJ:“This refusal appears to be violating longstanding policies to defend and enforce Acts of Congress; will have a significant negative impact on the accessibility of healthcare for Americans; and appears to be driven by political considerations rather than considered legal arguments. The Department owes Congress and the public an explanation as to why it refuses to enforce the law and we request that you provide previously requested information to us and make certain individuals available for questioning.” April 9, 2019: NARAL Pro-Choice America posted a press release titled: “Senate Judiciary Committee holds hearing on unconstitutional abortion ban”. From the press release: As the Senate Judiciary Committee holds a hearing on an unconstitutional abortion ban, which would have grave consequences for women’s rights and lives, NARAL Pro-Choice America President Ilyse Hogue issued the following statement:“The GOP is engaged in a coordinated attack on reproductive freedom, aimed at overturning Roe v. Wade and punishing women. From introducing a patchwork of legislation this year in over a dozen states to criminalize abortion, to launching a full-blown misinformation campaign aimed at vilifying women and families, the GOP’s agenda has reached new heights of cruelty. We look to members of the Senate Judiciary Committee to stand against this relentless campaign of political overreach to control women’s lives, bodies, and futures.”Republicans in Congress have tried several times to advance unconstitutional abortion bans. This proposed legislation from Senator Lindsey Graham (R-S.C.) would criminalize abortion after 20 weeks of pregnancy, harming women and families who face some the most medically complex situations imaginable.Meanwhile, bills that would effectively outlaw abortion have been introduced in more than a dozen statehouses across the country – Alabama, Kentucky, Mississippi, Georgia, Missouri, Ohio, Tennessee, Florida, Illinois, Maryland, Minnesota, New York, South Carolina and West Virginia. This session, Kentucky Governor Matt Bevin signed into a law a bill to ban abortion before many women know they are pregnant. April 9, 2019: CBS News posted an article titled: “Lindsey Graham introduces bill which would ban abortions after 20 weeks.” It was written by Grace Segers. From the article: Sen. Lindsey Graham, Republican from South Carolina, is once again introducing the Pain-Capable Unborn Child Protection Act, which would ban abortions after 20 weeks. Graham has sponsored this bill every year since 2013 only to have it defeated again and again in Congress.This year might be different, thanks to a conservative majority in the Supreme Court and several restrictive abortion measures being passed in Republican-controlled states across the country. But the bill would still need 60 votes to bypass a filibuster and pass the Senate, an extremely unlikely outcome given that Republicans control only 54 seats in the chamber. And it would also need to pass the House, which now has a substantial Democratic majority……The legislation has never been able to clear the hurdle of invoking cloture, a procedural vote which allows legislation to advance to the Senate floor for a full vote……Democrats argue that such a bill would restrict a woman’s right to choose what happens in her body and violate Roe v. Wade, the landmark 1973 Supreme Court decision that legalized abortion nationwide……Supreme Court Chief Justice John Roberts sided with the court’s four liberal justices to block a restrictive abortion law in Louisiana from going into effect in February. Court watchers say Roberts, a Republican appointee and former official in the Reagan administration, may still be hesitant to overturn judicial precedent on the matter. April 9, 2019: CNBC posted an article titled: “Sen. Grassley: Pharmacy ‘middlemen’ hearing should lead to a bill to end ‘secrecy’ in drug industry”. It was written by Berkley Lovelace, Jr. From the article: The Senate Finance Committee’s hearing with executives from pharmacy benefit managers will hopefully soon be followed by legislation to bring drug prices down and end the “secrecy” in the drug industry, Chairman Sen. Chuck Grassley told CNBC on Tuesday.Executives from CVS Health, Cigna, OptumRx, a subsidiary of United Healthcare, Prime Therapeutics and Humana, are scheduled to testify later in the day about high prescription drug costs. PBMs, sometimes referred to as “middlemen,” negotiate discounts with manufacturers for insurance plans and employers.Grassley and other lawmakers suspect these so-called backdoor deals between drug companies and pharmacy middlemen contribute to the high drug costs some consumers see at the pharmacy counter……The hearing Tuesday, led by Grassley, and Sen. Ron Wyden, D-Ore., marks the committee’s third on drug prices this year. In late February, the committee heard testimony from executives of AbbVie, AstraZenica, Bristol-Myers Squibb, Johnson & Johnson, Merck, Pfizer, and Sanofi.The pharma executives at the time pointed the blame at middlemen for pocketing discounts instead of passing them along to patients. The executives didn’t commit to, or even suggest, lowering their list prices. Some referenced these prices as simply the price that’s advertised, not what consumers actually pay……Grassley said Tuesday there’s already plenty of proposed legislation to bring down drug costs. He mentioned the CREATES Act, a bill introduced by Sen. Patrick Leahy, D-Vt., which aims to stop drugmakers from withholding samples of their medicines from generic manufacturers, thus increasing competition and lowering costs. April 9, 2019: The Illinois Department of Healthcare and Family Services posted a press release titled: “Fulfilling Gov. Pritzker’s commitment to healthcare equity, Medicaid to provide for gender affirming surgery”. From the press release: Fostering healthcare equity and inclusion, the state’s Medicaid program will begin covering gender affirming surgeries for members under new policies being established, the Illinois Department of Healthcare and Family Services announced today.“Healthcare is a right, not a privilege, and I’m committed to ensuring our LGBTQ community and all Illinoisans have access to that right,” said Governor Pritzker. “Expanding Medicaid to cover gender affirming surgeries is cost effective, helps avoid long term health consequences, and most importantly, is the right thing to do. With continued attacks coming from Washington, this administration will always stand with our transgender community and their right to lead safe and healthy lives.”The Department has begun developing administrative rules to offer this coverage. Input from stakeholders and the public will be considered during the public comment period. The Department anticipates coverage will become available to Medicaid members upon adoption of the administrative rule, which is likely to be this summer.Under the proposed coverage rules, Medicaid members age 21 and older who are diagnosed with gender dysphoria will now be eligible for genital and breast-related surgeries.In studying other state policies, the Department found that in addition to addressing the struggles associated with gender dysphoria, gender affirming surgery is also cost-effective. HFS determined that the policies of the State of Vermont particularly offer a comprehensive and appropriate approach and has been using these as a model.Coverage for the procedures serve to prevent negative health impacts – such as depression and suicide. Seventeen states and the District of Columbia offer these services and have not reported significant cost increases. The most recent data available shows that 1,400 of the state’s 3.1 million Medicaid members are diagnosed with gender dysphoria, and last year around 2,500 prescriptions for hormone therapy were covered……The U.S. Department of Health and Human Services in 2016 set rules to require access to gender transition services. However, the previous administration in Illinois did not create the policies and coverage requirements to accomplish this.The new policy will include Medicaid members in HealthChoice Illinois, the state’s managed care program, as well as those receiving their care through traditional fee-for-service.When the policy is finalized, the Department will reach out to medical providers, stakeholders, and the LGBTQ community to promote awareness of the new coverage. April 9, 2019: CBS News posted an article titled: “Illinois Medicaid to cover “gender affirming” surgery”. It was written by Caitlin O’Kane. From the article: Illinois’ Medicaid program will begin to cover gender affirming surgery, the state’s Department of Healthcare and Family services (HFS) said in a statement last week. Medicaid members 21 and older, who are diagnosed with gender dysphoria, will be eligible for genital and breast-related surgeries, according to the statement……1,400 of the 3.1 million Medicaid members in Illinois are diagnosed with gender dysphoria, recent data shows, according to the agency. Last year, around 2,500 prescriptions for hormone therapy were covered.The Department made this announcement the week of International Transgender Day of Visibility, which is observed on March 31.Last month, the Iowa Supreme Court ruled that the state could not deny Medicaid coverage for the surgeries of two transgender women, The Associated Press reports. April 10, 2019: Planned Parenthood posted a press release titled: “Ohio To Become Sixth State to Ban Abortion Before Many People Know They’re Pregnant”. From the press release: Today, admit large protests at the statehouse the Ohio General Assembly passed Senate Bill 23, the dangerous six-week abortion ban. Once it is signed by Governor MikeDeWine, Ohio will be the sixth state to ban abortion before many people know they’re pregnant. The law has no exceptions for cases rape or incest and threatens felony charges to doctors who provide care to patients. This becomes the 22nd restriction to reproductive health care in Ohio that has been enacted since 2011. Ohio is one of 16 states to pursue a six-week-ban, revealing a 63% uptick in these types of abortion bans this year.This attack comes two weeks after the Sixth Court of Appeals upheld a law the bars Planned Parenthood from funding programs that provide essential health services and education and after a temporary injunction was placed on the bill that seeks to ban the dilation and evacuation procedure, which is the most common second trimester abortion procedure, to prevent it from being enforced. It’s clear that politicians will stop at nothing to ban abortion in Ohio. The press release includes a statement from Dr. Leana Wen, President of Planned Parenthood Federation of America: “Ohio’s six-week ban is a dangerous policy designed to block abortion access before many women know they’re pregnant. This is yet another attack we are seeing on the health and well-being of the residents of Ohio. Just two weeks ago, the Sixth Circuit Court of Appeals upheld a law that bans Planned Parenthood form programs that provide life-saving services including STD and HIV tests, breast and cervical cancer screenings, and domestic violence education, as well as the Healthy Moms, Healthy Babies program aimed at reducing maternal and infant mortality. These actions will roll back gains to public health and harm women’s health and the health of families across Ohio. Planned Parenthood will not back down from this flight. Our parents in Ohio and across the country deserve the right to control their own body, life, future, no matter where they live or how much money they make.” April 10, 2019: NBC News posted an article titled: “Texas abortion bill proposes death penalty for women, physicians”. It was written by Dartunorro Clark. From the article: Texas lawmakers are considering a bill that would ban abortion in the state and charge women who have abortions with homicide, which can carry the death penalty in the state.Rep. Tony Tinderholt, a Republican, introduced the “Abolition of Abortion in Texas Act”, or House Bill 896, in January to “protect the rights of an unborn child” but was granted his first committee hearing on Monday and Tuesday.Nearly 500 people testified, with 54 testifying against the bill, according to The Washington Post……Tinderholt introduced a similar bill in 2017, bit it failed to leave committee. He was placed under state protection because of death threats he received after proposing the bill, according to The Texas Tribune……The bill would ban abortion at any stage of pregnancy and would criminalize women who have abortions and the physicians who perform them, even in cases of rape, human trafficking or incest. The bill directly conflicts with the landmark Roe v. Wade decision, which outlawed criminalizing abortion… April 10, 2019: NARAL Pro-Choice Ohio posted a press release titled: “NARAL Pro-Choice Ohio statement on Ohio’s six-week abortion ban”. From the press release: The Ohio General Assembly has passed Senate Bill 23, which will effectively end access to all abortion care in Ohio if enacted.NARAL Pro-Choice Ohio Executive Director Kellie Copeland said: “Today, the GOP majorities in the Ohio House and Senate voted to virtually outlaw abortion and drag us into a dystopian nightmare where people are forced to continue pregnancies regardless of the harm that may come to them or their family. We will stand in support of Ohio’s abortion providers as they challenge this attack on the public health in court. We will stand with Ohioans as they seek the abortion care they need.“The passage of this six-week ban on safe, legal, accessible and affordable abortion is not the will of the majority. It is the act of the minority which abused their power to gerrymander Ohio’s legislative districts to give them the power to force their out-of-touch ideology on our state. We will work day and night to upend this attack on democracy to ensure that Ohio will once again have fair elections that result in elected officials that share our values and support reproductive freedom.”In a media event held before the House vote, pro-choice advocates were joined by members of the Ohio House Democratic Caucus in speaking against the bill.Ashley Underwood represented NARAL Pro-Choice Ohio at the event: “Those of us born with wombs are not voiceless vessels. We are not incubators. We are not the concubines of movements whose moral compass instructs them to deny us our autonomy. Our bodies should not be treated as the sole piece of incriminating evidence when conception is the result of violation and violence. And yet, each time the Ohio legislature further restricts abortion access for the thousands of constituents who need it, the state of Ohio treats us as such,“Abortion is healthcare. Abortion is a life saving procedure. Abortion is moral. And good people have abortions”. April 10, 2019: Senator Chuck Grassley (Republican – Iowa) posted a news release on his official website titled: “Grassley, Senators Introduce Bill to Protect Pre-Existing Conditions Coverage.” From the news release: Senate Republicans believe in patient-centered health care that delivers the choices they want, the affordability and protections they need, and the quality care they deserve. That’s why U.S. Sen. Chuck Grassley of Iowa today joined Sen. Thom Tillis of North Carolina and 16 other senators in introducing the Protect Act, legislation that would protect Americans with pre-existing conditions and ensure that Americans have the peace of mind knowing that they and their loved ones will never be denied health insurance coverage or be charged more because of a pre-existing condition……Joining Grassley and Tillis as co-sponsors as the Protect Act are Sens. Lamar Alexander of Tennessee, Bill Cassidy of Louisiana, Rob Portman of Ohio, David Perdue of Georgia, Joni Ernst of Iowa, John Cornyn of Texas, Kevin Cramer of North Dakota, Johnny Isakson of Georgia, Roger Wicker of Mississippi, Shelley Moore Capito of West Virginia, John Barasso of Wyoming, Rick Scott of Florida, John Kennedy of Louisiana, Todd Young of Indiana, Tom Cotton of Arkansas, and Richard Burr of North Carolina.The Protect Act amends the Health Insurance Portability and Act (HIPPA) to:Guarantee the availability of health insurance coverage in the individual or group market, regardless of pre-existing conditions;Prohibit discrimination against patients based on health status – including prohibiting increased premiums for patients due to pre-existing conditions;Prohibit insurance companies from excluding coverage of treatments for a beneficiary’s pre-existing condition. There was no further information about the Protect Act on Senator Grassley’s website. Senator Thom Tillis has a link on his website that leads to what looks like a pamphlet about The Protect Act. It is very vague. Here are some key points from that pamphlet: The three fundamental principles of the Protect Act are: Protection, Affordability, and Choices.Protection: The Protect Act guarantees coverage for pre-existing conditions and prohibits insurance companies from excluding coverage of treatments for a patient’s pre-existing condition.Affordability: The Protect Act prohibits insurance companies from charging you higher premiums due to pre-existing conditions.Choices: The Protect Act guarantees the availability of health insurance coverage in the employer or individual markets for you and your loved ones regardless of whether or not you have a pre-existing conditions.Does the Protect Act repeal or replace Obamacare? No. The Protect Act does not strike down, weaken, or change a single provision from Obamacare, nor is it designed to be a replacement for Obamacare.Why isn’t the Protect Act a more comprehensive health care bill? This billl demonstrates the commitment of Republicans to protect Americans with pre-existing conditions, regardless of the future of Obamacare. The senators who introduced the bill have made it clear that they are wiling to work with anyone – Republican and Democrat alike – who want to reform our broken health care system and ensure Americans have access to quality and affordable health care.The second page of the two page pamphlet is propaganda. It tries to convince people that the Republican’s idea version of health care is “patient-centered reform”. It also tries to convince people that “government-run health care” is bad. This part is mostly using the same, old, Republican talking points that have been used since before Obamacare was signed into law. It includes scare tactics like: “While the government can’t even run your local DMV properly, there are politicians in Washington who are proposing a total government takeover of your health care. That means if you like your current health insurance, you won’t be able to keep it, because the private plans that over 180 million Americans rely on would become illegal. In addition to paying higher taxes, it would also mean fewer choices for you and your family. With government bureaucrats in charge, you won’t be able to get the health care you want, when you need it. That means you and your loved ones could wait months or longer to get the treatment you need.”This scare tactic is designed to subtly convince Americans that Obamacare is bad. It is also designed to frighten Americans away from voting for politicians who want single-payer health care, Medicare for All, or Universal Health care. Plenty of other countries have universal health care plans (UK, Canada, Australia – to name a few), and their systems work much better, are less expensive, and is more patient focused than anything the United States has.In short, Obamacare already protects Americans by prohibiting insurance companies from excluding or dropping people because of their pre-existing conditions, from refusing to cover the care for pre-existing conditions, or from charging people with pre-existing conditions more for their coverage. Universal health care would provide those same protections because it means every American is covered and can access care for a very affordable cost.The Protect Act is a talking point that Republicans are going to use as we head towards the 2020 election. It is an empty idea that doesn’t offer anything we don’t already have in Obamacare. It was created so Republicans have something to point at when Americans, rightly, point out the many times Republicans have tried to pass health care bills that would entirely exclude coverage for pre-existing conditions (or price that coverage too high for most Americans to afford). If you would like more information about Universal Health Care, I recommend you check out my blog post titled: “America Needs Universal Health Care“. My blog has way more information about universal health care, and more specific details about various plans for it, than the Republicans Protect Act does. April 11, 2019: The American Civil Liberties Union of Ohio (ACLU) posted a press release titled: “ACLU of Ohio to Challenge Total Abortion Ban”. From the press release: The ACLU of Ohio announced today that it will file a lawsuit challenging Senate Bill 23, legislation that would ban all abortions in the State of Ohio. Governor Mike DeWine is expected to sign the bills in the coming days. The named plaintiff in the lawsuit will be Northeast Ohio based abortion care provider, Preterm-Cleveland. Additional plaintiffs will include Planned Parenthood of Greater Ohio, Planned Parenthood of Southwest Ohio, and the Women’s Med Center of Dayton.The ACLU will argue that the banning of abortion at six weeks, or with the detection of a fetal heartbeat, is a direct violation of the Constitution and a complete undermining of Roe v. Wade. Similar lawsuits have been filed against so-called “heartbeat bills” in four other states (Iowa, Kentucky, Arkansas and North Dakota) and the courts have struck all of the abortion bans down as unconstitutional… April 11, 2019: TIME posted an article titled: “Ohio Governor Signs Bill Banning Abortion After First Heartbeat”. From the article: A bill imposing one of the most stringent abortion restrictions in the nation was signed into law in Ohio.Republican Gov. Mike DeWine signed the heartbeat bill Thursday, breaking with his predecessor, Republican John Kasich, who had vetoed the measure twice.Ohio’s closely divided politics had slowed the progress of the bill as it has caught momentum elsewhere, forcing years of debate in the state where the bill originated……DeWine’s action came a day after the latest version of the bill, which outlaws abortions once a fetal heartbeat is detected, cleared the Republican-controlled Legislature. Doctors say a fetal heartbeat can be detected using transvaginal ultrasound technology as early as five weeks into pregnancy, before many women know they are pregnant.Even before the bill was signed, the ACLU of Ohio said it was preparing a constitutional challenge to the law on behalf of Pre-Term Cleveland and three other Ohio abortion clinics.The legal challenge is what bill’s backers have always wanted. They hoped to provoke a legal challenge with the potential to overturn the U.S. Supreme Court’s 1973 Roe v. Wade ruling that legalized abortion up until viability, usually at 22 to 24 weeks……The law makes no exceptions for pregnancies resulting from rape or incest……The latest version of the bill passed out of an Ohio House committee Tuesday. The Full House approved it Wednesday and, that same day, the Senate agreed to House changes and sent it to DeWine… April 11, 2019: NARAL Pro-Choice Ohio posted a press release titled: “DeWine Abortion Ban Attacks Woman”. From the press release: In response to the signing of an unconstitutional attack on the right to safe and legal abortion, NARAL Pro-Choice Ohio Executive Director Kellie Copeland released the following statement:“Today and everyday, we will not accept barriers places on abortion access by politicians or judges. We refuse to be intimidated by shame and stigma. No one should be forced to carry a pregnancy against their will. None of us will have reproductive freedom until all of us do.“Governor DeWine, we’ll see you in court.”All seven surgical abortion clinics, and two providers offering medication abortion services, will be open tomorrow serve patients. April 11, 2019: Des Moines Register posted an article titled: “Chuck Grassley: Supreme Court unlikely to overturn Obamacare, so no need to create replacement”. It was written by Tony Leys. From the article: U.S. Senator Chuck Grassley said Thursday he doubts a Republican lawsuit will succeed in getting the Affordable Care Act overturned.“I don’t believe the courts are going to strike it down,” the Iowa Republican said in a phone interview with the Des Moines Register……Like other Republicans, he has been critical of the Affordable Care Act. The wide-ranging law is also known as Obamacare, because then-President Barack Obama, a Democrat, signed it in 2010……Trump told reporters last month, “The Republican Party will soon be known as the party of health care – you watch.”But Grassley said Thursday there is no pressing need for Republicans to create a comprehensive plan to replace Obamacare. “We don’t have to work on a replacement, because it’s unclear what the courts are going to do,” he said.Grassley said he expects the Supreme Court to uphold the Affordable Care Act, as it did in a 2012 decision, in which Chief Justice John Roberts was the deciding vote. “I would be very doubtful… that he’s going to be changing his mind,” Grassley said.He touted a bill he co-sponsored this week that would bar insurers from discriminating against people with pre-existing health problems. But he said the bill would not be debated unless the Affordable Care Act is struck down, because that law already protects Americans with pre-existing conditions.He acknowledged this week’s bill doesn’t address related issues, such as the use of current Obamacare subsidies to help moderate-income Americans buy health insurance before they become ill. Without such measures, insurers could decide to stop selling health policies on the individual market, where people turn for coverage if they aren’t eligible for insurance from employers or from Medicaid or Medicare… April 11, 2019: National Law Journal posted an article titled: “DOJ’s Brett Shumate, Key Civil Division Lawyer, Just Announced He’s Leaving”. It was written by C. Ryan Barber. From the article: Brett Shumate, a top political appointee in the U.S. Justice Department’s Civil Division, is stepping down after a two-year stint crisscrossing the country in defense of the Trump administration’s policies……Shumate did not respond to a request for comment. A person close to Shumate noted that two-year tenures are standard for political appointees and said he plans to spend time with his family before taking the next career step. He has not selected or committed to any law firm, the person said.Shumate was among the leading lawyers on the Justice Department that abandoned the defense of the Affordable Care Act in the U.S. Court of Appeals for the Fifth Circuit, which is weighing the constitutionality of the Obama administration’s signature health care law. In a reversal, the Justice Department said last month it will now endorse the Texas trial lawyer’s decision declaring the entirety of the Affordable Care Act unlawful.The government this week asked the court to set an expedited argument schedule and to hear the case by July. Main Justice has not yet announced who will argue for the government. The government’s abrupt refusal last year to defend part of Obamacare spurred several career Justice Department lawyers to withdraw their appearances in the case… April 15, 2019: KCUR.Org posted an article titled: “Kansas Give Up On Its Long-Running Effort to End Planned Parenthood’s Medicaid Funding”. It was written by Dan Margolies. From the article: Kansas has dropped its effort to terminate Planned Parenthood’s participation in Medicaid, ending a three-year-long court battle that the state lost at every turn.The change in policy wasn’t announced publicly but rather came in the form of a joint stipulation to dismiss Planned Parenthood’s lawsuit challenging the state’s move.The stipulation, which was filed in federal court on Friday, stated that the Kansas Department of Health and Environment (KDHE), which oversees the state Medicaid program, has notified Planned Parenthood of its decision to rescind the Medicaid terminations. The court approved the dismissal of the lawsuit on Monday morning.Ashley All, a spokeswoman for Kansas Gov. Laura Kelly, said the state’s decision to end the litigation came after multiple court rulings against the previous administration.“To continue with this costly litigation would be unwise and out of step with the priorities of Kansas,” All said. “Gov. Kelly is focused on expanding healthcare options to women, not limiting them.”Still up in the air is the extent to which Kansas will be required to reimburse Planned Parenthood for the legal fees it incurred. Both sides have requested an additional 60 days to resolve the matter. The legal fees are likely to amount to several hundred thousand dollars, if not more, since the case has been litigated for three years and gone all the way up to the U.S. Supreme Court… April 15, 2019: Kaiser Family Foundation (KFF) posted information titled: “Uninsured Adults in States that Did Not Expand Who Would Become Eligible for Medicaid under Expansion”. From the information: Prior to the Affordable Care Act, Medicaid eligibility was limited to specific low-income groups, such as elderly, people with disabilities, children, pregnant women, and some parents. The ACA expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($17,236 for an individual in 2019). As of April 2019, 14 states have not adopted the ACA Medicaid expansion. Across all non-expansion states, 4.4 million uninsured non elderly adults would become eligible for Medicaid if all opted to expand their programs. The two-page fact sheets provide a snapshot with key data for those who would become eligible for Medicaid under expansion in non-expansion states. The following states did not expand Medicaid. Here is a list of information from KFF about Medicaid in those states: Wisconsin: Covers adults up to 100% FPL in Medicaid, but did not adopt the ACA expansion.South Dakota: If South Dakota were to expand its Medicaid program 29,000 uninsured non-elderly adults would become eligible for coverage, 45% of the state’s uninsured non-elderly.Wyoming: If Wyoming were to expand its Medicaid program 20,000 uninsured non-elderly adults would become eligible for coverage 37% of the state’s uninsured non-elderly.Kansas: If Kansas were to expand its Medicaid program 80,000 uninsured non-elderly adults would become eligible for coverage, 40% of the state’s uninsured non-elderly.Missouri: If Missouri were to expand its Medicaid program 219,000 uninsured non-elderly adults would become eligible for coverage, 47% of the state’s uninsured non-elderly.Oklahoma: If Oklahoma were to expand its Medicaid program 196,000 uninsured non-elderly adults would become eligible for coverage, 43% of the state’s uninsured non-elderly.Texas: If Texas were to expand its Medicaid program 1.4 million uninsured non-elderly adults would become eligible for coverage 36% of the state’s uninsured non-elderly.Mississippi: If Mississippi were to expand its Medicaid program 163,000 uninsured non-elderly adults would become eligible for coverage 53% of the state’s uninsured non-elderly.Alabama: If Alabama were to expand its Medicaid program 223,000 uninsured non-elderly adults would become eligible for coverage, 54% of the state’s uninsured non-elderly.Tennessee: If Tennessee were to expand its Medicaid program 207,000 uninsured non-elderly adults would become eligible coverage, 38% of the state’s uninsured non-elderly.North Carolina: If North Carolina were to expand its Medicaid program 379,000 uninsured non-elderly adults would become eligible for coverage, 40% of the state’s uninsured non-elderly.Georgia: If Georgia were to expand its Medicaid program 457,000 uninsured non-elderly adults would become eligible for coverage, 40% of the state’s uninsured non-elderly.South Carolina: If South Carolina were to expand its Medicaid program 211,000 uninsured non elderly adults would become eligible for coverage, 44% of the state’s uninsured non-elderly.Florida: If Florida were to expand its Medicaid program 837,000 uninsured non-elderly adults would become eligible for coverage, 36% of the state’s uninsured non-elderly. April 15, 2019: Axios posted an article titled: “For low-income people, employer health coverage is worse than ACA”. It was written by Drew Altman, Kaiser Family Foundation. From the article: …But new data show that health insurance is decidedly less affordable for lower income people who get coverage at work than for their counterparts with similar incomes in the marketplaces……The details: A low-income family with a marketplace plan pays 8.4% of their income on premiums and out-of-pocket costs, compared to 14% for a lower-wage family with employer coverage (those with incomes below time the poverty level).That’s based on Current Population Survey data on what people at that income level paid for employer coverage, plus exchange premium data collected from Healthcare.gov and state-based ACA marketplaces.How it breaks down:For low-income families with marketplace plans, the out-of-pocket costs are 4.7% of their income, while the premiums are just 3.7% of their income.For those with coverage through work, the out-of-pocket costs are 5% of their income, roughly the same as families with marketplace plans.The big difference is in the premiums – because the low-income families with workplace coverage pay about 9% of their income to cover those payments.The largest share of group insurance premiums, paid by employers, also depress wages for lower-wage and other workers……The bottom line: Employer-based coverage by far is the largest source of health insurance, and it now provides the least financial protection for lower income workers who need it most. We debate affordability in the ACA marketplaces a lot, but we don’t talk about this far larger problem much, if at all. April 19, 2019: KSHB 41 Kansas City posted an article titled: “Kansas to let Farm Bureau health coverage avoid ACA rules”. From the article: Kansas will allow its state Farm Bureau to offer health care coverage that doesn’t satisfy the Affordable Care Act after Democratic Gov. Laura Kelley on Friday declined to block a Republican-backed effort to circumvent former President Barack Obama’s signature health care law.Kelly allowed an insurance bill to become law without her signature, and it includes provisions that will exempt the bureau from state insurance regulations in the health care coverage it offers to its members……Kelly’s fellow Democrats strongly opposed the measure, suggesting it would allow the nonprofit to sell skimpy health care coverage while offering false hope to consumers.The proposal had overwhelming Republican support in the GOP-controlled Legislature. Kelly had not taken a position publicly before allowing the bill to become law.The new law takes effect in July. It is patterned after one in place in Tennessee for decades and one enacted last year in Iowa.Its enactment demonstrated the Farm Bureau’s political clout in Kansas, particularly in rural areas, where Republicans dominate politics. The bill also had the support of most urban and suburban GOP lawmakers who continue to oppose the 2010 federal health care overhaul.Some Democrats argued that rural communities would be better served by expanding the state’s Medicaid health coverage for poor residents as outlined in the Affordable Care Act, as Kelly has proposed. The House passed a Medicaid expansion plan last month, but the Senate has yet to take it up……Critics of the Farm Bureau’s proposal said companies offering traditional health insurance coverage would face unfair competition.They also focused on how the Farm Bureau would be able to set higher rates or reject coverage for people who have pre-existing medical conditions. They also suggested that coverage could be limited for large expenses, such as pregnancy or cancer treatment. April 22, 2019: The Chicago Tribune posted an article titled: “As health insurance prices soared, ‘the state was powerless to stop it.’ The House just passed a bill to change that.” It was written by Lisa Schencker. From the article: In recent years, many Illinois consumers were socked with steep price increases when buying health insurance on the Obamacare exchange.A bill that’s gaining traction in Springfield, however, could prevent that. The bill would give the Illinois Department of Insurance the power to say no to certain sky-high price increases proposed by insurance companies for plans sold to individuals and small businesses. The bill wouldn’t apply to plans offered by large employers.It’s a change proponents say could help protect consumers, while opponents of the bill say it does nothing to address the rising prices of health care that can lead to higher insurance prices, and it could limit the types of plans insurers are able to offer.The bill, introduced by Rep. Bob Morgan, D-Highwood, would allow the Department of Insurance to reject rate proposals, for individual and small group plans, that are “unreasonable,” meaning they’re excessive, unjustified, or unfairly discriminatory, as defined by the federal government. Now, Illinois reviews rates and may try to negotiate with insurers to bring them down, but the state generally can’t reject or change rates that are actuarially sound.The bill passed the House, 73-41, this month and is now awaiting hearing in the Senate. Many of the plans sold to individuals that would be affected by the bill are sold on the Obamacare exchange……Most people in Illinois get health insurance through employers or government programs such as Medicare and Medicaid. But this year, about 312,000 people in Illinois selected health plans through the Obamacare exchange.Lawmakers have tried to pass similar bills for years without success, but Morgan thinks his bill might stand a better chance this year because Blue Cross and Blue Shield of Illinois is neutral on it, rather than opposing it, he said. A spokesman for Blue Cross declined confirm the insurer’s stance on the bill, saying Blue Cross doesn’t comment on pending bills. A similar bill passed in the House in 2017 but then didn’t make it out of the Senate, through the bill’s sponsors are hopeful that changes made to this year’s bill will help it succeed……A spokeswoman for an insurance industry lobbying group, America’s Health Insurance Plans, noted in an email that the risking costs of doctor’s visits, hospital stays and medications all contribute to insurance prices……The Illinois Chamber of Commerce also opposes the measure… April 22, 2019: American Medical Association (AMA) posted a press release titled: “AMA applauds new federal primary care payment models”. From the press release: The American Medical Association (AMA) today commended the U.S. Department of Health and Human Services on their announcement that many primary care practices will be able to receive improved Medicare payments beginning next year through new payment models……Health and Human Services Secretary Alex Azar made the announcement at the AMA’s Washington Office during a meeting to discuss primary care delivery attended by more than 200 representatives of medical specialty societies and other stakeholders. He was joined by Centers for Medicare and Medicaid Services Administrator Seema Verma and Deputy Administrator for Center for Medicare and Medicaid Innovation (CMMI) Director Adam Boehler. They announced that CMMI will be inviting primary care practices to participate in several new alternative payment models that will allow primary care practices to provide new types of services to their patients that are not currently supported by Medicare payments.Innovative physicians have used grant funding to demonstrate that providing more convenient access to practices, enhanced care management for patients with chronic diseases, in-home services for patients with acute conditions, and palliative care for patients with advanced illnesses can significantly improve the quality of care for patients while reducing total health care spending. These new payment models have the potential to allow many more primary care physicians to deliver these high-value services to their patients while also saving money for the Medicare program.The AMA also commended Secretary Azar for basing the new payment models on proposals developed by practicing physicians and incorporating recommendations from the Physician-Focused Payment Model Technical Advisory Committee (PTAC)… April 23, 2019: Planned Parenthood posted a press release titled: “TITLE X VICTORY: Federal Court to Block Trump’s Gag Rule”. From the press release: Today, immediately after oral arguments, a federal district court judge in Oregon announced that he will issue a preliminary injunction to block the Trump-Pence administration’s gag rule on Title X, the nation’s only program dedicated to affordable birth control and reproductive care. In March, Planned Parenthood and the American Medical Association filed suit challenging the gag rule for being illegal, unethical, and threatening the health care of millions of people who rely on Title X health centers. The gag rule – which would have gone into effect May 3 – would bar providers from giving their patients complete information and block care at Planned Parenthood, even though Planned Parenthood servers approximately 40 percent of Title X patients, When people can’t see their provider of choice or cannot access a Title X provider at all, they delay or simply go without care……The case, which was filed in the United States District Court in Eugene, Oregon, was brought by the American Medical Association, Oregon Medical Association, Planned Parenthood Federation of America, Planned Parenthood of Southwestern Oregon, Planned Parenthood Columbia Willamette, Thomas N. Ewing, M.D. and Michelle P. Megregian, C.N.M. Planned Parenthood is being represented by attorneys from Planned Parenthood Federation of America and the law firms of WilmerHale and Stoel Rives. It seeks to protect the Title X program and guarantee that people receive full, unbiased information about their health care options – a right that has been repeatedly affirmed by Congress.Since 1996, Congress has mandated, annually, that patients receiving information about their pregnancies through Title X must receive “nondirective” counseling. And in 2010, Congress went even further, mandating that HHS cannot impose rules, precisely like the gag rule, that create unreasonable barriers to care, that interfere with doctors giving their patients a full range of options that restricts the ability of health care providers to disclose all relevant information to patients making health care decisions, or that violates the ethical standards of health care professionals. The gag rule blatantly violates Congress’ mandate by forcing doctors to withhold information from their patients and imposing unreasonable barriers to care. The press release included a statement from Dr. Leana Wen, President, Planned Parenthood Federation of America: This is a victory for patients and doctors in this country. Because of this, our patients across the country can still access the life-saving health care, like cancer screenings and STI treatments, they need through Title X, our nation’s only program for affordable birth control and reproductive health care. However, while this is a victory for patients and doctors, this relief is preliminary and we will continue to fight the Trump-Pence administration in court and in Congress to ensure our patients’ health and rights are protected. April 23, 2019: The American Medical Association (AMA) posted a press release titled: “Federal judge will enjoin family-planning physician gag rule”. It was written by And is Robeznieks, Senior News Writer AMA. From the press release: U.S. District Judge Michael J. McShane said Tuesday he will issue a temporary injunction against the Trump administration’s gag rule dictating what physicians can and cannot say about family planning to their patients in the Title X program. The AMA is the lead patient in the lawsuit to stop the rule, which was set to take effect May 3.The judge’s forthcoming written ruling will define the scope of that injunction. The ruling will also enjoin the rule’s requirement of financial and physical separation between Title X and non-Title X abortion-related activities.“Judge McShane got it exactly right when he called the new Title X rule a ‘ham-fisted’ approach to health care,” said AMA President Barbara L. McAneny, MD. “The judge repeatedly asked how the new gag rule would improve health outcomes. The government was unable to answer.“The new rule would have placed obstacles to health care for low-income patients,” Dr. McAneny added. “We are pleased the judge shared the AMA’s concern about the physician-patient relationship that the rule would have jeopardized.” April 24, 2019: Senator Elizabeth Warren tweeted: “We won’t go back on women’s health – not now, not ever. The Trump administration’s gag rule is immoral, dangerous, and illegal. Period. #ProtectX” The tweet included a link to a thread from Planned Parenthood about a federal court judge saying he would block Trump’s Title X gag rule. April 24, 2019: NOLA.com posted an article titled: “Backup Obamacare plans may be too expensive for Louisiana”. It was written by Julia O’Donoghue. From the article: Louisiana may not be able to replace federal mandates that guarantee access to health insurance for people with pre-existing conditions if the Affordable Care Act gets overturned without passing along hundreds of millions of dollars in increased health care costs to residents, according to analyses from the Louisiana Legislature’s nonpartisan fiscal office.President Barack Obama’s signature health care law may get thrown out if a lawsuit brought by governors and state attorneys general, including Louisiana’s Jeff Landry, is successful……Edwards, a Democrat, and Landry, a Republican, filed separate bills to maintain access to health insurance for people with pre-existing conditions and to allow young adults to remain on their parents’ plans, among other things. The bills would also prohibit health insurers putting annual or lifetime caps on health insurance benefits for individuals.But twin fiscal analyses determined that the bills would add hundreds of millions of dollars in expenses that health insurance companies would presumably pass along to consumers if Obamacare was completely overturned.Much of the expense can be attributed to the fact that striking down Obamacare would mean the federal government would no longer provide hundreds of millions of dollars in subsidies to Louisiana health insurance companies to provide coverage. The state has no source of funding to replace that money……Neither Landry’s nor the governor’s proposal addresses what will happen to the half million residents who receive health insurance through Medicaid expansion if Obamacare gets overturned. Medicaid expansion only came to be because of Obamacare. April 24, 2019: Politico posted an article titled: “HHS nearing plan to roll back transgender protections”. It was written by Dan Diamond. From the article: The Trump administration is preparing to roll back protections for transgender patients while empowering health care workers to refuse care based on religious objections, according to three officials with knowledge of the pending regulations.The long-expected rules have alarmed patient advocates and public health groups, which have warned the health department that the rules could harm vulnerable populations’ access to care. Meanwhile, the rules have been eagerly anticipated religious-rights groups in conservative states that have lobbied for the changes.The controversial rules – which the Trump administration has been scrutinizing for more than a year to prepare for expected legal challenges – have been closely guarded inside the administration, following several media reports on the efforts that sparked backlash and complicated official’s strategy. Officials say the two health department rules are now expected within the next 10 days.One rule would place an Obama administration policy extending nondiscrimination protections to transgender patients, which have been blocked in court. A second rule would finalize broad protections for health workers who cite religious or moral objections to providing services such as abortion or contraception, a priority for Christian conservative groups allied with the administration.The Obama administration issued transgender patient protections as part of a rule enforcing Obamacare’s Section 1557 provision banning discrimination in health care based on sex, but they were halted in 2016 by a Texas federal judge who found Congress didn’t intend to protect gender identity. The Justice Department this month told the judge it agreed with the ruling and signaled that the administration would soon issue a replacement rule……Officials told Politico the forthcoming conscience regulations build on an administration proposal from last year, but they declined to offer more details. That proposal would give HHS “a lot more authority and power” to effectively remake and enforce existing conscience protections, said Katie Keith, a Georgetown University law professor who’s studied the regulations.For instance, a medical school receiving federal funds could not deny admission to applicants who refuse to preform abortions; providers could not require staff to inform patients about services like sterilization procedures or advance directives rejecting end-of-life care; and doctors and nurses would gain further protections to refuse providing services like vaccinations.The forthcoming HHS nondiscrimination rules are the latest example of President Donald Trump violating a campaign pledge to protect the LGBTQ community, advocates for transgender people say. The administration’ ban on transgender troops took effect just a few weeks ago, and the health department reportedly tried to effectively eliminate the federal definition of “transgender”… April 25, 2019: The Atlantic posted an article titled: “Some Immigrants Choose Between Food Stamps and a Green Card”. It was written by Olga Khazan. From the article: …In October, Donald Trump’s administration released a proposed rule that, if finalized, would affect a part of immigration policy known as “public charge.” From the founding of the country, several American states expelled immigrants deemed too poor or otherwise “undesirable.” The U.S. government formally codified the practice in the form of the Immigration Act of 1882. The term public charge has, in past decades, been applied loosely, as Public Radio International has reported….…More recently, the provision has applied to foreigners who hope to immigrate and noncitizen already in the United States who are likely to need long-term institutional care or government cash assistance. The government might consider those factors when it comes time to decided who should be allowed to obtain visas or green cards. With the Trump administration’s new proposed rule, though, the U.S. government would broaden the definition of a public charge, examining whether immigrants have used public-health programs such as food stamps or Medicaid during their time in the United States. Immigration officials could then look less favorably on legal immigrants who used those benefits when they seek to obtain green cards or extend their immigration status.Though the number of immigrants whom the new public-charge determination would apply is much smaller, the consulting firm Manatt estimates that as many as 41.1 million non-citizens and their families, or 12.7 percent of the U.S. population, could be deterred from using public benefits because of a chilling effect resulting from the proposed change……In addition to the proposed public-charge rule change, in January of 2018, the State Department gave embassies and consulates wider leeway to consider the likelihood that a visa applicant would become a public charge when determining whom to let in to the country. Consular officers are now allowed to take into account the past or current use of government programs by a visa applicant’s family when deciding whether to grant an applicant entry. Subsequently, State Department data revealed that visa denials on public-charge grounds rose threefold from 2017 to 2018……Immigrants became nervous about using public benefits almost immediately after Trump’s election, perhaps due to the president’s inflammatory theoretic about foreigners. But emerging data from around the country suggest that these and other recent proposals have heightened this fear. Though some of the rules haven’t been implemented yet, the mere discussion of these changes has been enough to scare many immigrant families away from health services for which they or their children are eligible……Social-service providers, doctors, and attorneys describe immigrant communities that are rife with misinformation and fear. Their immigrant patients and clients steer clear of even those government programs that won’t count against them, in some cases hurting their health as a result….…Doctors and immigrant-aid attorneys told me they are conflicted about how to counsel immigrant families about using government programs. They emphasize that the rule has only been proposed. Technically, nothing has changed yet. But many nevertheless feel uneasy assuring immigrants that they won’t be affected. Sometimes, advocates said, to times down to the individual family’s tolerance for risk… April 25, 2019: The Center for Reproductive Rights posted a press release titled: “Federal Court Blocks Gag Rule Nationwide”. From the press release: Today, a federal district court judge in Washington state issued a preliminary injunction blocking changes to the Title X federal family planning program from taking effect. The case was brought by Washington State and the National Family Planning and Reproductive Health Association, and argued before U.S. District Court Judge Stanley Bastian.Some provisions of the new rule, issued by the Trump Administration, had been scheduled to start taking effect May 3, but are now blocked until the case can be heard. The new Title X rule is also being challenged in Maine, California, Maryland, and Washington.Similarly, the Center for Reproductive Rights also is challenging the Gag Rule in a federal district court in Maine, on behalf of Maine Family Planning which is the sole Title X grantee in the state. The Center and Maine Family Planning also have asked for an injunction from the district court in Maine. A hearing was held on that motion yesterday, and the judge is expected to rule in coming days. But, now the people of Maine like others around the country, will be covered by the nationwide injunction out of Washington……Earlier this week, a federal district court in Oregon announced plans to enjoin the Domestic Gag Rule.For decades, existing regulations have prevented federal funds, including Title X, from being used for abortion services. The Domestic Gag Rule goes far beyond that, forcing clinics to stop performing abortions altogether or lose their funding for other reproductive health services, which would put many out of business. The rule would also prohibit doctors at these facilities from making referrals to abortion providers, even when the patient has already decided to have an abortion and directly asks for a referral. Instead, doctors would be forced to give all pregnant patients prenatal referrals, regardless of whether the patient the patient neither wants nor needs that information. April 25, 2019: OZY posted an article titled: “Forced to Divorce: Americans With Disabilities Must Pick Marriage or Health Care”. It was written by Carly Stern. From the article: …Couples with disabilities historically have faced greater barriers to marriage. But an OZY investigation reveals a rapidly widening disparity in marriage rates between those with and without disabilities in the years since Susan’s divorce, spawned by outdated eligibility thresholds and a convoluted web of health care programs that many find difficult to navigate.Between 2009 and 2018, nearly 1.1 million Americans with disabilities got divorced, almost twice the number – 593,000 – that got married, U.S. Census Bureau data show. In the same time period, 1.5 million people without disabilities divorced – less than a third of the 5.2 million who got married. This “divorce gap” raises the question of how many more like Susan are ending happy marriages to secure health care……But across the country, couples with disabilities face the added burden of complex regulations that critics say are out of step with the times. Supplemental Security Income (SSI), a federal program meant for Americans with disabilities with limited resources or over the age of 65, is only available to couples with $3,000 or less in assets. This cap has remained in place since 1989 – although the equivalent of $3,000 then would be more than $6,000 in 2019. And for a couple with disabilities, monthly SSI was benefits are reduced by 25 percent upon marriage to account for the efficiency of shared expenses like housing, according to the Office of the Chief Actuary.Individuals who qualify for the Disabled Adult Child program, which is linked to their parents’ work history, lose benefits upon marriage. What’s more, the Office of Inspector General and Social Security Administration (SSA) can determine that a cohabitation couple is “holding out to the community as though they are married” – which would strip them of the benefits they sacrificed marriage to protect. “When two people consider themselves to be married and convert that to the community, they are considered married for SSI purposes whether they are legally married or not,” says Nicole Tiggmann, a public affairs specialist at the SSA.Some states are trying to avoid the marriage-or-health-care dilemma. Certain ones have raised Medicaid income and asset caps for people with disabilities who are able to work. Some offer specific buy-in programs or assess disability based on the applicant’s income alone. But even with those higher thresholds, the annual eligibility caps for workers with disabilities in 30 out of 50 states are below $34,489, America’s per capita income, according to the Census Bureau’s latest available data from 2017. Then there’s the legal morass of complex regulations that advocates say are poorly communicated by the responsible agencies.In effect, all of this means that many Americans with disabilities must pick only two out of three: marriage, economic security and comprehensive health coverage. “As we see amazing strides in marriage equality, disabled people are still being excluded form the conversation,” says Robyn Powell of Brandeis University’s Lurie Institute for Disability Policy… April 25, 2019: Indy Star posted an article titled: “ACLU sues Indiana over near-ban on most common second-trimester abortion procedure”. It was written by Kaitlin Lange. From the article: The American Civil Liberties Union of Indiana has filed a lawsuit against the state two days after Gov. Eric Holcomb signed two abortion measures into law.Specifically, the ACLU is challenging House Enrolled Act 1211, which bans dilation-and-evacuation abortions except when the mother is at risk of “substantial and irreversible physical impairment of a major bodily function” or when the fetus is no longer viable.Dilation and evacuation is the most common type of second-trimester abortion in Indiana, according to Indiana State Department of Health data. However, second-trimester abortions overall are rare in the state……Nevertheless, opponents of the measure emphasize that dilation and evacuation can oftentimes be the safest way to abort a fetus during the second trimester. The American College of Obstetricians and Gynecologists says it has fewer complications than other types of abortions in the second trimester.The ACLU says the new law is unconstitutional.“HEA 1211 will discourage women from obtaining abortions and will impose a substantial and unwarranted burden on women’s ability to obtain second-trimester, pre-viability abortions,” said Ken Falk, legal director at the ACLU of Indiana. “In addition, doctors have an ethical obligation not to subject their patients to potentially harmful procedures that provide no medical benefit. This law would force doctors to do just that.”… April 25, 2019: Politico posted an article titled: “Judge freezes Trump abortion rule”. It was written by Alice Miranda Ollstein. From the article: A federal judge in Washington on Thursday blocked a Trump administration rule that would have overhauled the Title X federal family planning program and cut funding to health providers that offer abortions or abortion referrals.U.S. District Court Judge Stanley Bastian, an Obama-appointee, issued a nationwide injunction staying the charges from taking effect while several other legal challenges proceed. Bastian heard several hours of arguments from Washington state and the National Family Planning and Reproductive Health Association challenging the administration’s Title X funding rule and arguments from the Justice Department defending the changes……Nearly two dozen states and several medical provider and advocacy group have sued to block the rule. Some of those states as well as all Planned Parenthood affiliates had also threatened to drop out of the Title X program entirely if the rule takes effect, forfeiting millions of dollars and leaving low-income women in many areas with few or no options for free or subsidized care.Ruth Harlow, a senior staff attorney with the ACLU Reproductive Freedom Project who represented a coalition of about 750 Title X-funded organizations, said the judge seemed sympathetic to her argument that the rule was contrary to the purpose of Title X and was arbitrary and capricious. But she added, “This is just temporary. We will be fighting this in the next phase to make this permanent and make sure this rule is never resurrected.”……The states and groups challenging the Trump administration rule argued that it would violate both state and federal law – particularly parts of the Affordable Care Act that prohibit the government from interfering with patient-provider communications “regarding a full range of treatment options” or restricting providers’ ability to disclose “all relevant information to patients making health care decisions.” Some of the challengers also argue this rule violates the Administrative Procedures Act and the First Amendment…. April 25, 2019: The New York Times posted an article titled: “Judge Temporarily Blocks Trump Rule on Abortion Referrals”. It was written by Pam Belluck. From the article: A federal judge on Thursday issued a nationwide injunction temporarily blocking a controversial Trump administration rule that would bar organizations that provide abortion referrals from receiving federal family planning money. Judge Stanley A. Bastian of the United States District Court for the Eastern District of Washington State said in his order that the rule would cause family planning clinics “to face a Hobson’s choice that harms patients as well as the providers.” Judge Bastian wrote that the plaintiffs in the case had “submitted substantial evidence of harm” if the administration’s rule were to take effect. “Yet,” he wrote, “the government’s response in this case is dismissive, speculative and not based on any evidence presented in the record before this court.”The judge’s ruling granted an immediate preliminary injunction, preventing the imposition of the Trump administration rule, which was scheduled to take effect on May 3……Bob Ferguson, Washington’s attorney general, who had filed the case along with the National Family Planning and Reproductive Health Association, said his office would return to court to ask the judge to make the injunction permanent……The case filed in Washington State was one of several legal challenges to the Trump administration rule, including cases in California and Maine… April 25, 2019: The American Civil Liberties Union (ACLU) tweeted: “BREAKING: We just won a nationwide injunction blocking Trump’s attacks on the Title X family planning program. This is a victory for all Americans – especially for patients who turn to Title X. We will not stop fighting for everyone’s right to get the care they need.” April 26, 2019: U.S. Representative Jackie Speier tweeted: “This is a big win for women and for reproductive rights, but it won’t be long until @realDonaldTrump’s next attack on both. We have to be ready to defend #TitleX and fight to protect our rights against his administration. #ProtectX”. The tweet included a link to a CNN article about a federal judge in Washington state granting a preliminary injunction on Trump’s “gag rule”. April 26, 2019: NPR posted an article titled: “Kansas Supreme Court Rules State Constitution Protects Right To Abortion”. It was written by Dan Margolies and Celia LLopes-Jepsen. From the article: The Kansas Constitution protects a woman’s right to an abortion, the state Supreme Court ruled Friday.The landmark ruling now stands as the law of the land in Kansas with no path for an appeal. Because it turns on the state’s Constitution, abortion would remain legal in Kansas even if the Roe v. Wade case that established a national right to abortion is ever reversed by the U.S. Supreme Court……The decision, in which one of the seven justices dissented, cites in its first sentence the first section of the Kansas Constitution’s Bill of Rights: “All men are possessed of equal and inalienable natural rights, among which are life, liberty, and the pursuit of happiness.”The decision continues: “We are now asked: ‘Is this declaration of rights more than an idealized aspiration? And, if so, do the substantive rights include a woman’s right to make decisions about her body, including the decision whether to continue her pregnancy? We answer these questions, ‘Yes’.”“The state may only infringe upon the right to decide whether to continue a pregnancy,” the ruling continued,” if the State has a compelling interest and has narrowly tailored its actions to that interest.”The court took up the question of a constitutional right to abortion after two abortion providers in Overland Park, Kan., doctors Herbert Hodes and his daughter Traci Nauser, challenged a ban on dilation and evacuation abortions passed by the legislature in 2015….…Hodes and Nauser’s challenge to the law as unusual in that they did not argue the statute is illegal under the U.S. Constitution. Rather, they based their argument on the Kansas Constitution, contending that Sections 1 and 2 of its Bill of Rights recognize a “fundamental right to abortion”… April 26, 2019: Los Angeles Times posted an article titled: “Federal judge blocks Trump administration from imposing new rule on family planning clinics in California”. It was written by Maura Dolan. From the article: A federal judge in San Francisco decided Friday to block the Trump administration from denying federal funds to family planning clinics in California that make abortion referrals.The ruling by U.S. District Judge Edward Chen followed a similar decision by a federal judge in Washington state to bar the government from imposing the new restrictions there.A judge in Oregon has also indicated he would rule similarly in a challenge brought in that state.Chen said the new rule, which was to take effect next Friday, “commands medical professionals to provide incomplete and misleading information to women seeking to terminate their pregnancies.”The funding is delivered under a 1970 law, Title X of the Public Health Service Act……The new rule also would require clinics to refer pregnant women to a healthcare provider for prenatal health services, even if the client wanted an abortion……California, which serves 1 million patients annually under the Title X program, and Essential Access Health Inc., a nonprofit group that administered the state’s Title X program, sued to block the rule in California.Issuing a preliminary injunction, Chen said the restrictions would “compromise providers’ ability to deliver effective care and force them to obstruct and delay patients with pressing medical needs.”“Abortion is a time-sensitive procedure,” Chen wrote. Medical risks and costs rise with deal, he said.If the rule were to take effect, many providers would drop out of the program and the amount and quality of family planning services in California would decline, he said. Chen did not issue a nationwide injunction, saying the challengers were both based in California and had not cited sufficient evidence of harm in other states… April 26, 2019: California Attorney General Xavier Becerra tweeted: “#BREAKING: a federal court has granted an injunction in our case defending #TitleX from Trump-Pence Administration attacks. The million + CA women who rely on Title X for family planning services will continue to receive care while our lawsuit continues. #NoGagRule #ProtectX” The tweet includes a screenshot of a portion of the lawsuit. April 28, 2019: The New York Times posted an article titled: “Trump Repeats a False Claim That Doctors ‘Execute’ Newborns”. It was written by Chris Cameron. From the article: What Trump Said: “The baby is born. The mother meets with the doctor. They take care of the baby. They wrap the baby beautifully. And then the doctor and the mother determine whether or not they will execute the baby.”President Trump revived on Saturday night what is fast becoming a standard, inaccurate, refrain about doctors “executing babies.” During a more than hourlong speech at a rally in Green Bay, Wis., Mr. Trump admonished the Democratic governor, Tony Evers, for vetoing a Republican bill that could send doctors to prison for life if they fail to give medical care to children born alive after a failed abortion attempt.The comments are the latest in a long string of incendiary statements from the president on abortion……In another fact check, The Times found that infants are rarely born alive after abortion procedures:“It hardly ever happens, according to Dr. David Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. He performs abortions and is a spokesman for the American college of Obstetrics and Gynecologists, where he leads a committee on health care for underserved women. Infants are hardly ever born alive after attempted abortions, though there are rare cases when an infant survives a premature birth but cannot survive without extreme attempts at resuscitation.”Moreover, The Times reported, doctors do not kill the infants who survive, although families may choose not to take extreme measures to resuscitate them:“Dr. Grossman said there were painful situations in which the fetus might be at the edge of viability and labor must be induced to save the mother’s life. For instance, a condition called pre-eclampsia, involving high blood pressure and other problems, can kill both mother and fetus, and in most cases the only treatment is to deliver the baby. If it seems unlikely that the baby will survive, the family may choose to provide just comfort care – wrapping and cuddling the baby – and allow the child to die naturally without extreme attempts at resuscitation…” April 28, 2019: Senator Patty Murray tweeted: “Let’s be clear: President Trump is spreading these outrageous, deeply harmful lies because his party is laser-focused on taking away the right to safe, legal abortion in our country.” Senator Patty Murray also tweeted: “It’s up to all of us to keep calling these lies what they are and standing up for women’s health and rights – and that’s exactly what Democrats are going to do.” April 29, 2019: NARAL Pro-Choice America posted a press release titled: “NARAL Responds to Trump’s Escalation of Disinformation About Abortion”. From the press release: After Donald Trump’s remarks at a rally in Wisconsin, again pushing dangerous lies and disinformation, NARAL Pro-Choice America President Ilyse Hogue issued the following statement:“Trump stood up on Saturday night and not only straight-up lied but also vilified women, families, and doctors facing situations every single one of use prays we never encounter. His behavior personifies cruelty and responsibility and his actions diminish the office of the President.“What Trump asserted, for the second time, is false, illegal, and simply not happening – nor would it happen.“Sometimes, later in pregnancy, a woman gets a diagnosis of a serious complication that threatens her life or health. Other times, a family learns later in pregnancy there is a very serious fetal anomaly. Other times, the baby is dying and can’t survive for long. In all these cases, absolutely no one cares more than the parents involved and the medical professionals attending to these families. Certainly not Donald Trump. I think we can all agree that should our families ever face those unbearable circumstances, we should be left alone from politicians seeking to score political points and advance their cruel agendas.”Every pregnancy is different and every woman’s circumstances are different. People make these difficult, complicated, and personal medical decisions because of a serious diagnosis that endangers the woman’s life, a devastating fetal anomaly, or near-impossible barriers to care. The only way to correctly respond to these Lise is to reject the anti-choice movement’s intentional disinformation behind them… April 29, 2019: The Daily Beast posted an article titled: “How House Dems Plan to Stop Trump’s Birth Control ‘Gag Rule”. It was written by Laura Bassett. From the article: Democratic leadership has found a way to block President Trump’s domestic “gag rule” on abortion: The House will only pay for a federal family planning program that doesn’t include it……The rule, which was supposed to take effect this week, was temporarily blocked by a federal judge after Planned Parenthood filed a lawsuit against it. And House Democrats, who mainly control the nation’s purse strings, included language in their annual Labor-HHS Appropriations Act on Monday that would permanently block the abortion gag rule by refusing to allocate funds toward implementing it……This approach may face long odds in the Republican-controlled Senate. However, two key Senators, Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), have signaled they are open to blocking the change. The senators co-wrote a letter saying they oppose Trump’s abortion gag rule when it was first reported last year, and Collins said in February that she was considering legislative remedies to block its implementation……The Senate Appropriations Committee drives the Senate’s negotiations with the House, and Labor-HHS appropriations bills typically do not go to the Senate floor before that conference takes place. So it’s likely that the House version will go to a full vote in the Senate, putting pressure on Republicans to either fund this decades-old family planning program as it has been carried out for decades or scrap the whole government funding bill in order to keep birth control subsidies from Planned Parenthood and other providers.Trump also has the power to veto the appropriations bill, it wouldn’t be the first time he signed appropriations bills before that include provisions he didn’t like… April 30, 2019: Senator Kamala Harris tweeted: “Something you may have missed: a federal judge recently issued a nationwide block on the Trump administration’s dangerous restrictions on abortions through Title X. This is a win – but we must keep up the fight to protect women’s health care. #ProtectX”. April 30, 2019: The American College of Obstetricians and Gynecologists (ACOG) posted a statement titled: “ACOG Denounces False Claims About OB-Gyns”. From the statement: Lisa Hollier, M.D., M.P.H., president of the American College of Obstetricians and Gynecologists, issued the following statement in response to false claims made regarding the delivery of abortion care:“The American College of Obstetricians and Gynecologists (ACOG) strongly denounces the grossly inaccurate description of ob-gyns and the women they care for.“The theoretic used to describe the delivery of abortion care was offensive, wrong, and dangerous. Claims of this sort undermine the public’s trust in ob-gyns and stigmatize necessary health care for women.“Politicians must never use inflammatory language that can contribute to or encourage hostility or violence toward doctors, other medical professionals or individuals seeking or receiving health care.“As the largest organization of women’s health care providers, ACOG proudly stands behind our members who provide comprehensive health care for women, delivered with quality, safety, integrity, and compassion.” April 30, 2019: The American Civil Liberties Union (ACLU) of Alabama posted news titled: “ACLU of Alabama Comment on Abortion Ban”. From the news: Today, the Alabama House will consider HB314, the most restrictive abortion ban in the country which would criminalize abortion with no exception for rape or incest. The bill passed with a vote of 74-3.The ACLU of Alabama testified two weeks ago in the House Health Committee to make sure lawmakers knew that the ACLU would sue if they passed this bill. One of the previous lawsuits against legislation restricting access to abortion cost the state 1.7 million dollars in attorney fees.“We are disappointed that the Alabama House passed HB314 despite the fact it would criminalize abortion and interfere with a woman’s personal, private medical decisions. It is unfortunate that members of the House are putting their personal beliefs ahead of what’s in the best interest of our state. The people of Alabama are paying the bill for unconstitutional legislation and we hope the Senate members will realize its detrimental impact and stop this bill from becoming law. Otherwise it will be challenged in federal court.” April 30, 2019: The Center for Reproductive Rights posted a press release titled: “Oklahoma Court Strikes Down Restrictions on Medication Abortion”. From the press release: Today, the Oklahoma Supreme Court permanently blocked a 2014 Oklahoma measure (HB 2684) that restricts a woman’s access to medication abortion – a non-surgical method of ending an early pregnancy and the chosen method for more than 50% of all Oklahoma women.“Today’s decision is a critical victory for Oklahoma women and their doctors,” said Autumn Katz, Senior Counsel at the Center for Reproductive Rights. “Women deserve access to safe medication abortion regardless of what state they live in. This law would have required women to follow a decades-old practice that is no longer the standard of medical care. Today’s ruling elevates science over politics and ensures that Oklahomans who decide to end a pregnancy can continue to get the care they need.”As the Court concluded, “H.B. 2684 has the effect of placing a substantial obstacle in the path of a woman’s choice and imposes an undue burden on the woman’s right. Under United States Supreme Court precedent, [this law], is unconstitutional and therefore void and of no effect.”In September 2014, the Center for Reproductive Rights challenged Oklahoma’s restrictions on medication abortion signed into law by former Governor Mary Fallin – restrictions that would force physicians to treat women seeking medication abortion using an obsolete regimen that has been rejected by doctors, medical experts, leading professional organizations, and the FDA. As the Court noted, this law would have made Oklahoma the only state in the nation to enforce such an archaic protocol, increasing the rest of complications, banning all medication abortions after 49 days of pregnancy, and forcing women to undergo a surgical procedure when they otherwise would have the option of a safe abortion using medications alone……In November of 2017, a state district court permanently blocked the law. The State appealed that decision to the Oklahoma Supreme Court, which today upheld that decision. The state Supreme Court failed to permanently block the law in 2016. Subsequently, the U.S. Food and Drug Administration (FDA) approved an updated label for mifepristone (known as Mifeprex) in order to better reflect current practice and years of scientific evidence. Oklahoma is already one of the most restrictive states in the country in terms of abortion access. Since 2011, Oklahoma politicians have passed 20 bills restricting access to abortion and other reproductive health care. This year alone, a dozen anti-abortion bills have been introduced in the state. Just last week, Oklahoma enacted a bill that would require abortion clinics to post language that falsely claims it may be possible to “reverse” a medication abortion. The Oklahoma legislature is also currently considering SB 195, a constitutional amendment stating that the Oklahoma constitution does not protect the right to abortion… The Center for Reproductive Rights posted a copy of U.S. Judge of the Supreme Court of the State of Oklahoma, Patricia G. Parrish’s ruling. Here is the conclusion: Medical negligence or malpractice actions arise when a provider renders care that falls below the acceptable standard of care. Today, nineteen years after the FDA approved the 2000 label protocol, the FDA has approved a 2016 regimen that providers across the country use as the superior protocol. Use of the 2000 protocol agreeably would necessarily now fall below the acceptable standard of care. Not only would doctors potentially be medically negligent for following such standards, but also pursuant to H.B. 2684, they would be charged with a felony, incarcerated, and lose their license to practice through disciplinary proceedings for not following such sub-standard practices. Notwithstanding the effects H.B. 2694 has on doctors’ liability, this Court’s decision in Burns, supra and the United States Supreme Court precedents require us to question whether a statute has the effect of placing a substantial obstacle in the path of a woman’s choice and imposes an undue burden on the woman’s right. Under the facts and evidence presented in this cause, we agree with the trial court that H.B. 2684 does place a substantial obstacle in the path of a woman’s choice and imposes an undue burden on the woman’s right. The Constitution and the laws of the United States made in pursuance thereof shall be the supreme law of the land and senators, representatives, executive and judicial officers if this state are bound by oath to support this Constitution. Consequently, we affirmed the trial court’s declaration that H.B. 2684 is unconstitutional, void, and of no effect. We retreat what we said in In re Initiative Petition No. 349, State Question 642… “We will uphold the law of the land whatever it may be. Today the law of the land is that a woman has a constitutionally protected right to make an independent choice to continue or terminate a pregnancy before viability.” Apri 30, 2019: Senator Elizabeth Warren wrote an Op-Ed in Essence titled: “Sen. Elizabeth Warren on Black Women Maternal Mortality: ‘Hold Health Systems Accountable for Protecting Black Moms'”. From the Op-Ed: …I support these efforts, and I have another idea: hold health systems accountable for protecting black moms.My approach would apply to maternity care the lessons learned from successful reforms – many of enabled by the Affordable Care Act (ACA) – already revolutionizing other types of procedures, like joint replacements or cardiac care. Rigorous evaluations show these groundbreaking reforms hold immense promise. And maternal health has already been identified as one of the ripest areas for expansion.Rather than paying separately for each visit or each procedure, these new models set one price for an entire “episode” of care – and then hold health systems accountable for the outcome. The data show that these so-called “bundled payments” give health systems both greater incentives and greater control to improve results.In maternity care, health systems would have the flexibility to cover key services – like prenatal and postpartum visits, hypertension and depression screenings, and doula and lactation support – based on their effectiveness, not on their reimbursement rate. Outcomes could be tracked for a significant length of time after birth, to ensure that women and babies stay healthy during the postpartum period, and health systems could be pushed toward greater workforce diversity so care teams look more like the communities they serve.If health systems are able to coordinate their care and improve overall outcomes – like raising survival rates, reducing complications, and narrowing the mortality and morbidity gap between white women and women of color – they can earn a bonus. If care doesn’t improve, they’ll be on the hook. But they won’t be abandoned. Paying for better care means both rewarding excellent health systems and identifying, investing in, and demanding more from struggling ones….…In all of these decisions, women who have given birth, experienced complications, and lost babies – particularly women of color – and family members who have lost loved ones should not just be at the table: they should be calling the shots… May 1, 2019: The New York Times posted an article titled: “Trump Administration Files Formal Request to Strike Down All of Obamacare”. It was written by Jan Hoffman and Abby Goodnough. From the article: The Trump administration formally declared its opposition to the entire Affordable Care Act on Wednesday, arguing in a federal appeals court filing that the signature Obama-era legislation was unconstitutional and should be struck down.Such a decision could end health insurance for some 21 million Americans and affect many millions more who benefit from the law’s protections for people with pre-existing medical conditions and required coverage for pregnancy, prescription drugs and mental health……The filing was made in a case challenging the law brought by Ken Paxton, the attorney general of Texas, and 17 other Republican-led states. In December, a federal judge from the Northern District of Texas, Reed O’Connor, ruled that the law was unconstitutional.A group of 21 Democratic-led states, headed by California, immediately appealed, and the case is now before the Fifth Circuit Court of Appeals in New Orleans. The House of Representatives has joined the case as well to defend the law.Democrats wasted no time responding to the filing Wednesday. Xavier Becerra, the attorney general of California, a Democrat, said: “The Trump administration chose to abandon ship in defending our national health care law and the hundreds of millions of Americans who depend on it for their medical care. Our legal coalition will vigorously defend the law and the Americans President Trump has abandoned.”The government’s brief did not shed light on why it had altered its earlier position, referring only to “further consideration and review of the district court’s opinion.”Oral arguments in the appeals court are expected in July, with a possible decision by the end of the year, as the 2020 presidential campaign gets going in earnest. Where side loses is expected to appeal to the Supreme Court……As the administration and Texas noted in their briefs, Judge O’Connor’s ruling turned on the law’s requirement that most people have health coverage or be subject to a tax penalty. But in the 2017 tax legislation, Congress reduced that penalty to zero, effectively eliminating it. Judge O’Connor, the plaintiff states, and now the Trump administration reasoned that, like a house of cards, when the tax penalty fell, the so-called individual mandate became unconstitutional and unenforceable. Therefore, the entire law had to fall as well……If the Fifth Circuit overturns the O’Connor decision, there is no guarantee that the Supreme Court would take an appeal. The court has ruled on two earlier A.C.A. challenges, finding in favor of the act, although narrowing it.Of course, the composition of the Supreme Court has since changed. May 1, 2019: NPR posted an article titled: “Alabama Lawmakers Move to Outlaw Abortion In Challenge to Roe v. Wade”. It was written by Debbie Elliott. From the article: In what would likely become the most restrictive abortion ban in the country, the Alabama House Tuesday passed a bill that would make it a crime for doctors to perform abortions at any stage of a pregnancy, unless a woman’s life is threatened. The legislation is part of a broader anti-abortion strategy to prompt the U.S. Supreme Court to reconsider the right to abortion……Democratic lawmakers walked out in protest before the final 74 to 3 vote. During debate, they questioned the motive for an abortion ban in a state that’s refused to expand Medicaid……Other states, including neighboring Georgia and Mississippi, have passed laws that prohibit abortion once a fetal heartbeat can be detected. But Alabama’s ban would apply even earlier……The bill criminalizes abortion, meaning doctors would face felony jail time up to 99 years if convicted. The only exceptions are for a serious health risk to the pregnant woman, or a lethal anomaly of the fetus. There are no exceptions for cases of rape or incest. A woman would not be held criminally liable for having an abortion……[Representative Terri Collins’s ] bill cites abortion, the civil rights movement, and women’s suffrage as the justification for establishing the human rights of a fetus. Alabama is one of more than two dozen states seeking to restrict abortion rights this year, testing federal legal precedent that prevents states from banning abortion before the point at which a fetus could survive outside the womb……The bill is expected to win final passage in the Republican majority Alabama Senate. The ACLU of Alabama says it will sue if the abortion ban becomes law… May 1, 2019: The Skanner posted an article titled: “Gag Rule Threatens the Health of People of Color”. It was written by Sirius Bonner. She is the Director of Equity and Inclusion for Planned Parenthood Columbia Willamette. From the article: Donald Trump’s new gag rule is disastrous policy that will disproportionately impact communities of color, making existing barriers to health care for people of color even worse. It “gags” doctors and prevents them from telling patients about all their options, including abortion. It also threatens to block access to basic care at reproductive health centers…The idea of doctors withholding information or knowingly not offering patients access to available services is the anthesis of patient-centered care and, in this case, disproportionately impacts women who would not otherwise be able to identify and access those services on their own. The gag rule is unethical, illegal, and harmful to public health……Almost 50,000 Oregonians receive care through Title X. For many of our patients, we are their only source of care.There is already a massive divide between who does and who doesn’t have health care in Oregon, and the gag rule will only worsen these racial, socioeconomic and geographical health disparities. Due to discriminatory public policy and systemic racism, women of color with low incomes already face barrier in accessing health care and, under this gag rule, they’re going to bear the brunt of the harm… May 1, 2019: The Centers for Medicare & Medicaid Services (CMS) posted a blog on its official website titled: “Taking action and providing states options to minimize economic burden created by ACA”. It was written by Seema Verma, Administrator of Centers for Medicare & Medicaid Services. From the blog: …Today, the Departments are taking another step to prime discussions and are issuing a request for information (RFI) asking for more ideas on innovative programs and waiver concepts the states could consider in developing a State Relief and Empowerment Waiver plan, (also referred to as “Section 1332 waiver” or “State Innovation Waiver”)……CMS then took the extra step and released four waiver concepts that provide states with some examples of how they might use these new flexibilities. The concept that may hold the most promise to address various structural problems with the PPACA would be to establish a defined contribution to an account that individuals could manage, and could use to pay both health insurance premiums and any out-of-pocket health expenses. CMS also outlined new flexibilities for states to 1) establish a new state-administered premium subsidy to address well known structural problems in the insurance markets; 2) give people access to more health plan options that could be supported by state subsidies to increase consumer choice and affordability; and 3) implement new strategies to address the costs of high risk individuals the maintain the same strong protections for people with pre-existing conditions while reducing premiums for everyone else……In this RFI, the Departments are specifically asking for ideas for additional waiver concepts that states may be able to use to develop innovative waiver programs that meet the section 1332 guardrails, including the following possibilities:Waiver concepts that states could potentially use alone or in combination with other waiver concepts, state proposals, or policy changes;Waiver concepts that could advance some or all of the principles outlined in the 1332 Guidance released in 2018;Waiver concepts that incorporate the entire range of waivablue requirements allowed under section 1332; and How states might combine the flexibilities available under 1332 with other flexibilities that exist under federal law, including regulatory flexibility, Section 1115 Medicaid waivers, as well as state law.Comments for the RFI are due by July 2, 2019… May 2, 2019: Rewire News posted an article titled: “Trump Administration Finalizes Health-Care Discrimination Rule”. It was written by Jessica Mason Pieklo. From the article: The Trump administration on Thursday took another significant step in rolling back legal protections for LGBTQ patients, finalizing a rule that, if allowed to take effect, would allow individuals and health-care entities to refuse care to patients based on religious or moral objections.In January, the U.S. Department of Health and Human Services (HHS) announced it was close to finalizing an expansive new conscience protection rule for health-care providers. The rule permits providers to refuse to provide treatment, referrals, or assistance with procedures if these activities would violate their stated religious or moral convictions. The rule goes beyond refusing to provide health care; it also includes refusal for any health-related services, including research activities, health studies, or the provision of health-related insurance coverage.The final rule requires applicants for federal funding to provide assurances and certifications of compliance. The rule also specifies how individuals and health-care entities would comply with the new obligations, including cooperation with the HHS Office of Civil Rights (OCR), maintenance of records, reporting, and non-retaliation requirements……Trump’s announcement follows HHS’s overhaul at the end of April of the mission and vision statement listed on OCR’s website. The charges emphasize OCR’s role in protecting “conscience and free exercise of religion,” and were made at the same time as an HHS budget request that would weaken enforcement of civil rights protections for LGBTQ people… Here are some details that aren the “Protecting Statutory Conscience Rights in Health Care” rule: This rule concerns federal laws that provide: Conscience protections related to abortion, sterilization and certain other health services applicable to the Department of Health and Human Services and recipients of certain Federal funds…Conscience protections for health care entities related to abortion provision or training, referral for such abortion or training, or accreditation standards related to abortion.Protections from discrimination for health care entities that do not provide, pay for, provide coverage of, or refer for abortions under programs funded by the Department’s appropriations acts…Protections from discrimination under the Patient Protection and Affordable Care Act (“ACA”) for health care entities that do not provide any health care item or service furnished for the purpose of causing or for the purpose if assisting in causing ,the death of any individual, such as by assisted suicide, euthanasia, or mercy killing…Conscience protections regarding exemptions to the ACA’s individual mandate.Conscience protections under the ACA for qualified health plans related to coverage of abortion, and for individual health care providers and health facilities that do not provide, pay for, provide coverage of, or refer for abortions.Conscience protections for Medicare Advantage organizations and Medicaid managed care organizations with moral or religious objections to counseling or referral for certain services.Conscience protections related to the performance of advanced directives.Conscience and nondiscrimination protections for organizations related to Global Health Programs, to the extent such funds are administered by the Secretary of HHS.Conscience protections attached to Federal funding, to the extent such funding is administered by the Secretary, regarding abortion and involuntarily sterilization.Conscience protections from compulsory health care or services generally, and under specific programs for hearing screening, occupational illness testing, vaccination, and mental health treatment.Protections for religious nonmusical health care providers and their patients from certain requirements under Medicare and Medicaid that may burden their exercise of their religious beliefs regarding medical treatment. The next part refers to something called “The Church Amendments” which were enacted “at various times during the 1970s”. Here are some key points from “The Church Amendments”: …with regard to individuals, that no court, public official, or other public authority can use an individuals receipt of certain Federal funding as grounds to require the individual to perform, or assist in, sterilization procedures or abortions, if doing so would be country to his or her religious beliefs or moral convictions…prohibits those public authorities from requiring an entity, based on the entity’s receipt of Federal funds under certain HHS programs, to permit sterilizations or abortions in the entity’s facilities if the performance of such procedures there violates the entities religious beliefs or moral convictions, or to make its personnel available for such procedures if country to the personnel’s religious beliefs or moral convictions.…prohibits certain entities from discriminating in these decisions based on an individual declining to perform or assist in an abortion or sterilization because of that individual’s religious beliefs or moral convictions. It also prohibits those entities from discriminating in such decisions based on an individual’s performance of a lawful abortion or sterilization procedure, or in an individual’s religious beliefs or moral convictions about such procedures more generally…The next part applies to recipients of the Department’s grants or contracts for biomedical or behavioral research under any program administered by the HHS Secretary. “The Church Rules” prohibits discrimination by such entity against physicians or other health care personnel in employment, promotion, or termination of employment, as well as discrimination in the extension of staff or other privileges because of an individual’s performance or assistance in any lawful health service or research activity, declining to perform or assist in any such service or activity based on religious beliefs or moral convictions, or the individual’s religious beliefs or more convictions respecting such services or activities more generally.For health service programs or researcher activities that are funded in whole or in part under a program administered by the HHS Secretary, no individual shall be required to perform or assist in the performance of any part of the program or research activity if doing so would be country to his or her religious beliefs or moral convictions.For health care training or study programs, including internships and residencies, … prohibits any entity receiving certain funds from denying admission to, or otherwise discriminating against, applicants for training or study based on the reluctance or unwillingness to counsel, suggest, recommend, assist, or in any way participate in the performance or abortions or sterilizations contrary to, or consistent with, the applicants religious beliefs or moral convictions. Then, there’s the Coats-Snowe … rule?… that basically says that federal government and state or local government may not deny a legal status (including a license or certificate) to a health care entity based on an applicable physician training program’s lack of accreditation due to the accrediting agency’s requirements that a health care entity perform induced abortions; require, provide or refer for training in the performance or induced abortions; or make arrangements for such training. There’s a lot more in the rule – but I think you can probably see a pattern from what I’ve posted here. May 2, 2019: NPR posted an article titled: “New Trump Rule Protects Health Care Workers Who Refuse Care For Religious Reasons”. It was written by Alison Kodjak. From the article: The Trump Administration issued a new rule Thursday that gives health care workers leeway to refuse to provide services like abortion, sterilization or assisted suicide, if they cite a religious or conscientious objection.The rule, issued by the Department of Health and Human Services, is designed to protect the religious rights of health care providers and religious institutions……Last year [OCR Director Roger] Severino made it clear that defending religious freedom was his primary goal when he created a new Division of Conscience and Religious Freedom……As part of that change in focus, HHS in the last week changed the Office of Civil Rights’ mission statement to highlight its focus on protecting religious freedom.Until last week, the website said the office’s mission was to “improve the health and well-being of people across the nation” and to ensure people have equal access to health care services provided by HHS. But the new statement repositions the OCR as a law enforcement agency that enforces civil rights laws, and conscience and religious freedom laws, and “protects that exercise of religious beliefs and moral convictions by individuals and institutions.”That change, which was first noted by the Sunlight Foundation, dovetails with the new rule issued Thursday… May 2, 2019: Representative Lois Frankel (D-Florida) tweeted: “This is an outrage – Trump’s latest rule gives health care providers a free pass to discriminate. Denying services & care for patients based on personal beliefs is wrong & put people’s lives at risk, esp. women & the LGBTQ+ community. We won’t stand for this. #PutPatientsFirst”. The tweet included a link to a tweet by NARAL. May 2, 2019: Planned Parenthood Action tweeted: “BREAKING: The Trump administration just finalized a rule that, if allowed to take effect, could result in people being denied health care because of their health care providers’ personal beliefs. #PutPatientsFirst”. The tweet included an image with words in it that said: “The Trump administration just gave health care workers a license to discriminate, allowing doctors, nurses, pharmacists, and other health care providers to deny patients care and information based on their own personal beliefs.” The tweet was part of a thread. The next tweet in the thread said: “This rule would allow health care workers to put they personal cases and judgements ahead of people’s health – and it’s patients who will suffer”. That tweet includes an image with words on it that said: “Under the discriminatory refusal rule: Pharmacist could refuse to fill a birth control prescription.A transgender patient could be denied hormone therapyA hospital administrator could cancer life-saving cancer treatment because it might harm a patient’s pregnancy” May 2, 2019: The Center for Reproductive Rights posted a press release titled: “HHS Rule Will Encourage Discrimination Against Medical Patients”. From the press release: Today, the Department of Health and Human Services (HHS) finalized a Denial of Care Rule that will empower healthcare workers to turn a patient away for any moral or religious reasons. There are no limits on what constitutes a religious or moral denial, and it does not need to be a doctor who objects – it could be a hospital receptionist or an orderly booking an operating room.The Rule does not contain any provisions to ensure that patients who are rejected are referred elsewhere or offered other care options. The Rule will create confusion and invite employees to turn away patients without telling them that they’ve been denied complete care or why. The Rule completely fails to address how ti can be practically implemented, including in emergency situations. All facilities receiving funds through HHS must comply, including hospitals, urgent-care facilities, abortion clinics, and LGBTQ health centers. Under the Denial of Care Rule, facilities will be incentivized to cease offering contraception, abortion, and LGBTQ-focused care for fear of losing funding. The Rule also threatens the ability of clinics and smaller providers to stay open… May 2, 2019: Planned Parenthood tweeted: “No one should be denied health care – including safe, legal abortion – because of their provider’s beliefs. Your care should come first, not the biases or judgements of your health care provider. #PutPatientsFirst”. The tweet included a link to the @PPact Twitter account. May 2, 2019: The Human Rights Campaign posted an article titled: “Trump-Pence Admin Allows Medical Providers to Deny Lifesaving Care to LGBTQ People.” It was written by Charlotte Clymer. From the article: …”The Trump-Pence administration’s latest attack threatens LGBTQ people by permitting medical providers to deny critical care based on personal beliefs,” said HRC Government Affairs Director David Stacy. “The administration’s decision puts LGBTQ people at greater risk of being denied necessary and appropriate health care solely based on their sexual orientation or gender identity. Everyone deserves access to medically necessary care and should never be turned away because of who they are or who they love.”HHS announced today the issuance of the final rule that will sanction discrimination by healthcare providers who believe their personal beliefs should determine the care a patients receives. This rule could allow virtually any individual or entity involved in a patient’s care – from a hospital’s board of directors to the receptionist that schedules procedures – to put personal beliefs ahead of a patient’s health. This regulation will undoubtedly empower health care providers to deny necessary care to LGBTQ people and women.This regulation will deter health care organizations and providers from taking necessary action to guarantee that all patients have access to the care they not only deserve but are legally entitled to. In practice, the broad reach of the rule could allow health care providers to refuse to provide not only abortion and sterilization procedures, but also to deny treatment or preventative care for AIDS, or HIV, hormone therapy treatment and transition related care and in-vitro fertilization for lesbians, single women, or interfaith couples. The rule is especially dangerous for those already facing barriers to care, particularly LGBTQ patients, patients of color and those who are struggling to make ends meet… May 2, 2019: Dr. Leana Wen, President of Planned Parenthood, tweeted: “When I became a doctor, I took an oath to take care of my patients & provide the best medical care to them. In allowing doctors, nurses & other healthcare providers to deny care to patients, this administration is providing legal cover for discrimination. #PutPatientsFirst”. May 2, 2019: Representative Elijah E. Cummings tweeted: “Today’s HHS rule shamefully threatens access to #healthcare for far too many women and members of the #LGBT community. I urge the Administration to immediately abandon this rule and work with Congress to #putpatientsfirst.” May 2, 2019: Transgender Law Center posted a press release titled: “New HHS Religious Refusals Rule an Attack on Trans Communities.” From the press release: Today the Department of Health and Human Services (HHS) issued a final rule in effect allowing medical providers’ beliefs to dictate patient care.Kris Hayashi, executive director of Transgender Law Center, the largest national trans-led organization advocating for a world in which all people are free to define themselves and their futures, issued the following statement:Allowing medical providers a religious exemption to deny care to patients is outrageous, immoral, and dangerous. It’s commonsense for any patient to assume that healthcare providers, receiving taxpayer funding, will assist them and not deny them access to basic care. This rule undermines that basic principal.Reproductive justice is a critical issue for trans communities. We know that many trans people rely on the forms of reproductive health care targeted by this rule and that this will only lead to more barriers in accessing this care. As an added insult, while the rule explicitly targets access to reproductive health care and other related health services, the administration absurdly claims that it will not have a disparate impact on LGBTQ people, people of color, and people with disabilities who already experience disproportionately high rates of discrimination in health care. Allowing health care providers to discriminate in providing any service for any reason will lead to further discrimination, its that simple.Worse, this administration has signaled that it plans further, more explicit attacks on trans people’s access to health care. HHS has hinted that it will soon issue a rule questioning legal protections for trans people in medical settings. Transgender Law Center has worked in partnership with the National Center for Transgender Equality to launch the Protect Trans Health campaign to challenge the administration’s actions… May 2, 2019: Representative Joseph Kennedy III tweeted: “Allowing one person’s religious beliefs to dictate another person’s access to health care isn’t just discrimination, it’s deadly and dangerous. We will overturn this rule and restore equality to our health care system. #PutPatientsFirst”. May 2, 2019: The American Civil Liberties Union (ACLU) tweeted: “BREAKING: Trump’s HHS issued a rule today allowing for discrimination in health care when there is a “moral or religious objection”. Preventing people from accessing critical medical care may endanger people’s lives, especially trans people and those seeking reproductive care.” May 2, 2019: Mother Jones posted an article titled: “The Trump Administration Just Said Religious Doctors Can Refuse Medical Treatment for Patients”. It was written by Olivia Exstrum. From the article: Health care providers can refuse to provide medical care, including contraception, abortion, and procedure for transgender patients, that violates their religious moral beliefs, according to regulations published by the Department of Health and Human Services on Thursday…The rules specifically mention abortion, sterilization, and assisted suicide as services that health care providers can opt out of performing for religious reasons. The rules only make a passing mention of gender, saying that the department has received a number of comments asking whether the part of the rule that allows doctors to refuse to preform sterilizations on moral grounds included sterilizations because of gender dysphoria, such as a hysterectomy (removal of the uterus). The department references related cases, and says if it receives any complaints about having to perform a sterilization despite moral objections, it will review them on a case-by-case basis. According to Politico, the administration is also expected to issue more specific rules that would roll back discrimination protections for trans patients… May 2, 2019: The Texas Tribune posted an article titled: “Texas Senate advances bill requiring pre-abortion counseling”. It was written by Arya Sundaram and Elizabeth Bryne. From the article: The Texas Senate advanced a bill on Thursday that would require pregnant people to receive counseling before getting an abortion.Senate Bill 2243 would require a counselor to give pregnant women informational materials that detail the medical risks of the procedure and alternatives to abortion – a pamphlet that opponents say contains false information, although the law requires it to be medically accurate. The counselor would also inform the pregnant person about available local and state support services, including child care, medical care, housing, and employment assistance……While [Senator Angela] Paxton [wife of Texas Attorney General Ken Paxton], said that the counseling sessions would be “built around the convenience of the woman,” no such language exists in the big, and abortion rights advocates also worry that such a measure would add burdensome pressures on top of the state’s existing requirements.Bill opponents also fear that the legislation lacks key protections, like a requirement for the counselor to be a licensed medical professional. They also say a counselor could harass or pressure pregnant people against following through with the procedure……The bill was tentatively approved in a 21 to 10 vote, with Democratic state Sen. Eddie Lucio and Judith Zaffirini bucking their party to support the measure. The Health and Human Services Commission wouldst the counselor’s qualifications and monitor the counseling program, which would cost the state $1.9 million.Before getting an abortion, the pregnant person would have to show documentation of they counseling meeting. State Sen. José Menéndez, D-San Antonia, worried that a counselor could prevent the abortion by delaying the necessary documentation, so he added a provision that the counselor must issue the certificate within one business day or “as soon as practicable” after the appointment……The bill requires an additional vote before it moves to the House. May 2, 2019: Los Angeles Times posted an article titled: “Health insurance deductibles soar, leaving Americans with unaffordable bills.” It was written by Noam N. Levey. From the article: Soaring deductibles and medical bills are pushing millions of American families to the breaking point, fueling an affordability crisis that is pulling in middle-class households with health insurance as well as the poor and uninsured.In the last 12 years, annual deductibles in job-based health plans have nearly quadrupled and now average more than $1,300. Yet Americans’ savings are not keeping pace, data show. And more than four in 10 workers enrolled in a high-deductible plan report they don’t have enough savings to cover the deductible.One in six Americans who get insurance through their jobs say they’ve had to make “difficult sacrifices” to pay for healthcare in the last year, including cutting back on food, moving in with friends or family, or taking extra jobs. And one in five say healthcare costs have eaten up all or most of their savings.The conclusions are based on a nationwide poll the Times conducted in partnership with the nonprofit Kaiser Family Foundation, or KFF. Two Washington-based think tanks – the Health Care Cost Institute and the Employee Benefit Research Institute – provided supplemental analysis… May 2, 2019: Tampa Bay Times posted an article titled: “Pre-existing conditions coverage weakens in bill passed for post-Obamacare Florida”. It was written by Elizabeth Koh. From the article: Florida lawmakers approved a health insurance bill Wednesday that would require insurers keep covering pre-existing conditions if the Affordable Care Act disappears, though the bill would not keep protections in the federal law to control how much those patients can be charged.The bill, Senate Bill 322, which the House approved by 70-42 vote after the Senate passed it last week, would also expand short-term and association health plans and change requirements for “essential health benefits” covered by insurers, regardless of the status of the Affordable Care Act. It must be approved again by the Senate before it heads to Gov. Ron DeSantis for his signature.The bill originally started as a proposal that would just require insurers and organizations that manage healthcare to offer at least one policy offering coverage regardless of a pre-existing condition. It also stipulated that the requirement would only go into effect if the federal law was repealed or struck down in court.But the state Senate last week substantially amended the bill to tie it to the two other healthcare bills moving through the process as priorities of House Speaker José Oliva……But critics said the bill doesn’t have requirements that are in the Affordable Care Act to control prices on such plans and stop insurers from charging higher rates, and that changing the requirements for essential health benefits would weaken coverage. They also contended that the short-term and association plans authorized b the bill don’t provide enough coverage and could siphon away healthy people with cheaper rates. That, they added, would increase the number of sicker people on other plans and cause premiums to rise… May 3, 2019: Planned Parenthood Action tweeted: “.@HHSgov’s latest rule provides legal cover for discrimination. If this rule goes into effect, health care workers could refuse to provide care because of their personal beliefs – and patients will suffer as a result. #PutPatientsFirst.” The tweet includes a link to an article by Rewire News. May 3, 2019: Planned Parenthood Action tweeted: “‘[T]his administration is punishing community members who are the most impacted by health, education, and economic inequities.” – Sirius Bonner of @PPCW #ProtectX” The tweet included a link to an article from The Skanner, which was published on May 1, 2019. May 3, 2019: California Governor Gavin Newsom tweeted: “The latest Trump attack on healthcare: A new rule that would allow providers to discriminate against patients – with LGBTQ patients and women of color getting the worst of it. Medical standards should guild medical care. This policy puts lives at risk.” The tweet include a link to a Rewire article. May 3, 2019: ThinkProgress posted an article titled: “Iowa is a step away from limiting transgender people’s access to health care”. It was written by Casey Quinlan. From the article: Iowa is one signature away from enacting a law that would limit transgender people’s access to necessary health care.The law would allow government entities to opt out of using public insurance dollars, including Medicaid, to pay for any kind of transition-related care. The language was tacked on as an amendment to a health and human services appropriations bill late in the process, LGBTQ rights advocates said, without any committee hearings or public comment process. Lawmakers approved the legislation on Saturday.Now, its up to Gov. Kim Reynolds (R). The governor hasn’t signed the legislation yet, and LGBTQ groups are talking to her staff to convince her not to do so……The new legislation came a couple of months after a big court win for transgender Iowans. In March, the Iowa Supreme Court struck down the state’s ban on Medicaid coverage for sex reassignment surgery. In a unanimous ruling, the court sided with two transgender women whose health care providers said the surgery was necessary to treat their gender dysphoria.[Keenan] Crow [director of policy and advocacy at One Iowa, an LGBTQ advocacy group] said that One Iowa expected Republicans would wait about a year to introduce legislation like this and only heard serious discussion of the amendment in the past couple of weeks. Crow said it could have been much worse, since Republicans initially sought to remove gender identity protections from the Iowa Civil Rights Act……After speaking to more sympathetic Republicans, Crow said the language changed to effectively revers the recent court victory and not affect broader nondiscrimination protections for transgender people, including housing and employment. The current language adds and exemption to the Iowa Civil Rights Act that says a “state or local government unit or tax-supported district” is not requited to support transition-related care.The language specifically refers to “sex reassignment surgery” and any other cosmetic reconstructive or plastic surgery procedure related to transsexualism, hermaphroditism, gender identity disorder, or body dysmorphic disorder”……In addition to the language on transition-related health care, the appropriations bill include a provision to block Planned Parenthood from participating in state-funded sex education… May 3, 2019: Senator Kristen Gillibrand tweeted: “Representing Iowans means ALL Iowans. Signing this bill and widening health care disparities doesn’t make @IAGovernor a leader, it makes her a bully”. The tweet in response to the Iowa bill that is described in the ThinkProgress article above. May 3, 2019: The National Organization for Women (NOW) posted a statement titled: “Trump Expansion of Religious Refusal Targets Women, Shreds Democracy and Puts Politics Over Health Care”. From the statement: Donald Trump announced an expanded “conscience rule,” otherwise known as a religious refusal, that will further erode the government’s role in protecting women’s health, replacing the delivery of health care with partisan, extremist politics.The rule allows virtually any individual or entity involved in a patient’s care – from a hospital’s board of directors to the receptionist that schedules procedures – to put personal religious beliefs ahead of a patient’s health and deny medical care that includes abortion, reproductive health care and treatment for transgender patients.The Hippocratic oath dictates that medical professionals “do no harm,” but this new rule harms patients and tramples on their own deeply held values and beliefs……The new rule means rape survivors could be denied emergency birth control; same-sex couples could be denied fertility treatment, and women with an unintended pregnancy could be denied information and counseling on their options. Furthermore, health care providers take a pledge to provide care to anyone in need and this action is a violation of that fundamental standard……The Trump administration has taken this action ahead of the 2020 presidential election to incite his conservative base who oppose abortion and at the behest of conservative religious organizations who seek to advance their dangerous agenda regardless of whether it is sound medical practice. Meanwhile, millions of women and men in need will be denied crucial health care services… May 3, 2019: Snopes posted a fact check titled: “Do Women Meet With Doctors to Determine Whether to ‘Execute’ Newborn Babies?” It was written by Bethania Palma. From the fact check: Snopes determined that the claim was FALSE. During a 27 April 2019 political rally in Wisconsin, U.S. President Donald Trump made a false and incendiary remark, claiming that doctors and pregnant women confer with each other to decide whether to “execute” newborn babies. There is no truth to this statement……”It is not at all true,” said Dr. Daniel Grossman, professor of obstetrics, gynecology and reproductive sciences at the University of California at San Francisco, in regards to the president’s comments about “executing” babies. Doing so would be illegal, as illustrated in the infamous case of Kermit Gosnell, who was convicted of murder in 2013 for delivering babies of unwanted pregnancies and ending their lives by severing their spinal cords at his Philadelphia abortion clinic.Stories about babies surviving abortions and either being killed or callously left alone to die is a common pro-life trope, as are over-representations about the frequency and legality of late-term abortions.Grossman says a fetus likely could not survive an abortion, and if it did, the law requires that it be cared for in the same manner as any other baby of its same gestational age. (Although there’s no bright line, fetuses are generally considered viable outside the uterus sometime between the 24th and 26th week of gestation, depending on its health, Grossman said.)……Grossman told us that Trump’s most recent remarks are worrisome because while the physical safety of abortion providers has always been an immediate concern, the statement widens the target to include regular providers. “What he said most recently, that wasn’t really just talking about abortion providers. He was kind of implying that regular OB-GYNs might do what he described.”… May 3, 2019: NARAL Pro-Choice America tweeted: “Yesterday, Trump announced a rule that would allow an ambulance driver to refuse to provide transportation for women with etopic pregnancies – a condition that can be fatal if not treated – because the patient may need an abortion at the hospital to save her life. #PutPatientsFirst”. The tweet included an image from NARA Pro-Choice America that said: “Your healthcare provider’s personal beliefs should NEVER determine whether or not you receive critical healthcare services.” May 6, 2019: The American Civil Liberties Union (ACLU) of Virginia posted a press release titled: “Federal Court Issues Landmark Abortion Rights Victory in Virginia”. From the press release: Today, in a landmark ruling, the U.S. District Court for the Eastern District of Virginia became the first federal court to strike down a law prohibiting advance practice clinicians from providing first-trimester abortion care. These “physician-only” laws – which are on the books in 34 states – have no medical basis and are designed to restrict abortion by mandating that only physicians can provide abortion care, despite evidence that non-physician healthcare providers can safely and effectively provide such care. As a result of today’s ruling, qualified medical professionals such as nurse practitioners and physician’s assistants will be able to provide first-trimester abortions in Virginia. This case was brought by the Center for Reproductive Rights, Planned Parenthood Federation of American, the law firm O’Melven and Meyers, and local counsel of the ACLU of Virginia on behalf of various abortion care providers, including Falls Church Healthcare Center, Whole Womans Health Alliance, the Virginia League for Planned Parenthood, and Dr. Doe.In his decision, Judge Henry E. Hudson found that first trimester abortions “do not require the onsite presence of a licensed physician… As the Supreme Court has often restated, ‘unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right'”… The Center for Reproductive Rights posted the same press release. May 3, 2019: Kaiser Family Foundation posted polling titled: “KFF Poll: Public Opinion and Knowledge on Reproductive Health Policy”. From the polling information: …In this poll, KFF examines public opinion towards many different facets of reproductive health care, with a focus on recent changes to federal reproductive health policy made by the Trump administration. In particular, the administration recently finalized major changes to the Title X program, which provides federal funding for family planning services for lower-income people. If implemented, these changes would prohibit Title X funds from going to any family planning organization that also provides abortion referrals. The new regulation could also channel federal family planning funds to “non-traditional” organizations that only offer natural family planning methods or promote abstinence and do not provide other contraceptive services. The implementation of the new rule was recently halted by court order, but litigation continues. The Trump administration also recently expanded the Mexico City Policy, which restricts federal funding to organizations abroad if they provide abortion services or counseling or referrals for abortions.This poll also examines public attitudes toward laws that have recently passed by a number of states prohibiting abortions after a fetal heartbeat has been detected and before many women even know they are pregnant. The poll continues KFF’s tracking of the public’s awareness of provisions related to women’s health that are part of the 2010 Affordable Care Act (ACA). Key Findings: The poll continues to find strong support for federal government funding for reproductive health services for lower-income women, known as Title X funding. Majorities of Democrats and independents think it is important that the federal government provides this funding for lower-income women to access reproductive health services, as do a majority of Republican women (62 percent).Earlier this year, the Trump administration made major changes to federal rules regarding the Title X family planning program. The final rule included several changes, most notably blocking federal funding from any family planning provider that either offers or refers abortions to pregnant people – even though federal funds do not pay for abortions. On these changes, public opinion largely falls along party lines with most Democrats and independents opposing these changes. Republican are divided with similar shares supporting the Trump administration’s changes as opposing them. The rules have been challenged by numerous family planning organizers, providers, and state attorneys general and are currently temporarily blocked by court orders.Most Americans – including three-fourths of women ages 18-44 – say they are concerned (either “very” or “somewhat”) that access to women’s reproductive health and preventive care services may be limitedly the new rules that don’t allow clinics that provide abortions or refer for abortions to receive federal funding.The poll finds agreement across party lines on the issue of federal funding to groups that promote abstinence-only or natural family planning methods. At least half of Democrats, independents, and Republicans say they oppose federal funding going to organizations that do not provide a full array of contraceptive services. Majorities – across party identification – also oppose allowing federal funding to go to organizations that promote abstinence as the only option and do not teach young people about contraception and STD prevention.The poll also gauges awareness and attitudes towards restriction on U.S. funding for foreign non-governmental organizations that provide abortions or counsel or refer for abortions, using their own funds, known as the Mexico City Policy. While the majority of the public does not support such restrictions, views diverge along partisan lines, with most Democrats and independents opposing them and most Republicans supporting the actions by the Trump administration.In addition to the recent Trump administration’s actions on reproductive health care, there have also been state-level activities – including passing laws banning abortions after a fetal heartbeat can be detected (normally six weeks into a pregnancy). Opinions towards this type of legislation are largely partisan with Democrats (65 percent) opposing their state passing a similar ban and Republicans supporting it (70 percent) – including three-fourths of Republican women.The implementation of the Affordable Care Act (ACA) had major implications for women’s health, but this survey finds there is still confusion about what the 2010 health care law actually does in terms of women’s health care. Less than half the public are aware the ACA eliminates out-of-pocket costs for birth control (38 percent) and prohibits insurance companies from charging women more than men (36 percent). …Republican WomenWhile Republican women’s support for the Trump administration’s actions limiting federal funding from going to family planning clinics that provide abortions or referrals for abortions is similar to the support of Republican men. Republican women are more likely than their male counterparts to generally support Title X funding for reproductive health care for lower-income women. Six in ten Republican women (62 percent) say it is either “very important” or “somewhat important” the federal government provides funding for reproductive health service for lower-income women (compared to 96 percent of Democratic women, 85 percent of independent women, and 47 percent of Republican men). In addition, they are divided on whether the actions will limit access to women’s reproductive health and preventative care services. Slightly more than half (53 percent) say they are concerned that access will be limited by these new rules compared to 46 percent who say they are not concerned……While no federal funding to Planned Parenthood is used to pay for abortions, some states have proposed stopping all payments to Planned Parenthood for any family planning services, such as contraception or STI testing. Seven in ten (69 percent) would like their state to continue making payments to Planned Parenthood while about three in ten (29 percent) say all state payments to Planned Parenthood should be stopped. Views towards state payments to Planned Parenthood are largely partisan with nearly nine in ten Democrats (86 percent) and three-fourths of independents (74 percent) wanting to see state payments continue, while nearly six in ten Republicans (57 percent) want state payments to stop. Sizable majorities of women, overall (76 percent), and those 18-44 years old (87 percent) also support continuing state payments to Planned Parenthood. Republican women are divided with similar shares saying their state should stop payments (50 percent) as say the payment should continue (48 percent)……With multiple states passing bills aimed at restricting access to abortions, many legal scholars believe that the U.S. Supreme Court will be forced to take up one of these cases, thereby forcing the Court to revisit Roe v. Wade, the 1973 U.S. Supreme Court case which established a woman’s constitutional right to have an abortion. Overall, two-thirds of the public (65 percent) do not want to see the Supreme Court overturn Roe v. Wade, while about one-third (32 percent) would like to see the decision overturned.Unsurprisingly, attitudes are largely partisan with a majority (56 percent) of Republicans wanting to see Roe v. Wade overturned, while eight in ten Democrats and about seven in ten independents (68 percent) do not want the decision overturned. Two-thirds of women overall and seven in ten women ages 18-44 say they would like to see Roe v. Wade stay in place… May 6, 2019: Center for Reproductive Rights posted a press release titled: “Federal Court Issues Landmark Abortion Rights Victory in Virginia”. From the press release: Today, in a landmark ruling, the U.S. District Court for the Eastern District of Virginia became the first federal court to strike down a law prohibiting advanced practice clinicians from providing first-trimester abortion care. These “physician-only” laws – which are on the books in 34 states – have no medical basis and are designed to restrict abortion access by mandating that only physicians can provide abortion care, despite evidence that non-physician healthcare providers can safely and effectively provide such care. As a result of today’s ruling, qualified medical professionals such as nurse practitioners and physician’s assistants will be able to provide first-trimester abortions in Virginia.This case was brought by the Center for Reproductive Rights, Planned Parenthood Federation of America, the law firm, O’Melveny and Myers, and local counsel the ACLU of Virginia on behalf of various abortion care providers, including Falls Church Healthcare Center, Whole Woman’s Health Alliance, the Virginia League for Planned Parenthood, and Dr. Doe.In his decision, Judge Henry E. Hudson found that first trimester abortions “do not require the onsite presence of a licensed physician… As the Supreme Court has often restated, ‘unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”……The challenge to this law is part of a larger lawsuit – Falls Church Healthcare Center v. Oliver – challenging four Virginia laws that prevent and delay abortion access. A trial is set to begin on May 20, 2019, where the court will decide the constitutionality of the remaining three laws… May 7, 2019: Slate posted an article titled: “Georgia Just Criminalized Abortion. Women Who Terminate Their Pregnancies Would Receive Life in Prison.” It was written by Mark Joseph Stern. From the article: On Tuesday, Georgia Republican Gov. Brian Kemp signed a “fetal heartbeat” bill that seeks to outlaw abortion after about six weeks. The measure, HB 481, is the most extreme abortion ban in the country – not just because it would impose severe limitations on women’s reproductive rights, but also because it would subject women who get illegal abortions to life imprisonment and the death penalty.The primary purpose of HB 481 is to prohibit doctors from terminating any pregnancy after they can detect “embryonic or fetal cardiac activity,” which typically occurs at six weeks’ gestation. But the bill does far more than that. In one sweeping provision, it declares that “unborn children are a class of living, distinct person” that deserves “full legal recognition.” Thus, Georgia law must “recognize unborn children as natural persons” – not just for the purposes of abortion, but as a legal rule……But the most startling effect of HB 481 may be its criminalization of women who seek out unlawful abortions or terminate their own pregnancies. An earlier Georgia law imposing criminal penalties for illegal abortions does not apply to women who self-terminate; the new measure, by contrast, conspicuously lacks such a limitation. It can, and would, be used to prosecute women. Misoprostol, a drug that treats stomach ulcers but also induces abortions, is extremely easy to obtain on the internet, and American women routinely use it to self-terminate. It is highly effective in the first 10 weeks of pregnancy. Anti-abortion advocates generally insist that they do not want to punish women who undergo abortions. But HB 481 does exactly that. Once it takes effect, a woman who self-terminates will have, as a matter of law, killed a human – thereby committing murder. The penalty for that crime in Georgia is life imprisonment or capital punishment.HB 481 would also have consequences for women who get abortions from doctors or miscarry. A woman who seeks out an illegal abortion from a health care provider would be a party to murder, subject to life in prison. And a woman who miscarries because of her own conduct – say, using drugs while pregnant – would be liable for second-degree murder, punishable by 10 to 30 years’ imprisonment. Prosecutors may interrogate women who miscarry to determine whether they can be held responsible; if they find evidence of culpability, they may charge, detain, and try these women for the death of their fetuses.Even women who seek lawful abortions out of state may not escape punishment. If a Georgia resident plans to travel elsewhere to obtain an abortion, she may be charged with conspiracy to commit murder, punishable by 10 years’ imprisonment. An individual who helps a woman plan her trip to get an out-of-state abortion, or transports her to the clinic, may also be charged with conspiracy… May 7, 2019: CBS News posted an article titled: “Abortions after six weeks will now be illegal in Georgia”. It was written by Kate Smith. From the article: Georgia Gov. Kemp has signed into law the state’s “fetal heartbeat bill,” a piece of legislation that would prohibit abortion after a heartbeat is detected in an embryo. That is something that usually happens between five and six weeks into a woman’s pregnancy, before many women know they are pregnant……The bill appears to be a violation of Roe v. Wade, the landmark 1973 Supreme Court decision that protects a woman’s right to an abortion up until the fetus is viable, which typically happens between 24 and 25 weeks. The American Civil Liberties Union and the Center for Reproductive Rights have promised to challenge the legislation long before it goes into effect in January 2020.“This law is baffling unconstitutional,” said Elisabeth Smith, chief counsel at the Center for Reproductive Rights, in an email to CBS News on Tuesday morning. “Bans like this have always been blocked by courts. We will be suing Georgia to make sure this law has the same fate.”……Prior to Tuesday’s legislation, Georgia politicians have already passed a host of anti-abortion access laws, according to the Guttmacher Institute. Women in Georgia are required to wait 24 hours between requesting and obtaining an abortion in the state and minors are required to notify their parents. May 7, 2019: The Center for Reproductive Rights posted a press release titled: “Georgia Governor Signs Almost Total Ban on Abortion”. From the press release: Today, Georgia Governor Brian Kemp signed a bill (HB 481) that would effectively ban abortion outright. The law makes it a crime for doctors to provide an abortion once a heartbeat has been detected – around six weeks of pregnancy. Earlier this month, the Center for Reproductive Rights sent a letter to Governor Kemp urging him to veto the bill to no avail/Statement from Elisabeth Smith, Chief Counsel at the Center for Reproductive Rights:“This law is baffling unconstitutional. Bans like this have always been blocked by courts. We will be suing Georgia to make sure this law has the same fate.Even for women who find out they’re pregnant before six weeks, it would be nearly impossible to get an abortion before the cutoff. Georgia law requires a woman to visit a clinic twice before they can get an abortion, and, because Georgia law limits public and private insurance coverage of abortion, women must often safe up money to pay for the procedure.Georgia’s intentions are clear – they want this law to make it up to the Supreme Court to challenge Roe v. Wade. They see new justices on the court and think it’s possible. But the composition of the court has changed many times in the 46 years since Roe, and the Supreme Court has continuously reaffirmed the women have the right to decide to have an abortion.The Center is also suing Mississippi, which passed a six-week ban last month. The state passed a 15-week ban last year, which was struck down in court. Bans on abortion prior to viability have been struck down in various states including North Carolina, Mississippi, Arkansas, Arizona, Iowa, and North Dakota. North Carolina’s 20-week ban was struck down just last month. The Supreme Court recognized in Roe v Wade and reaffirmed just three years ago that a state cannot deny women the ultimate decision to terminate a pregnancy prior to viability.Georgia women already face state-imposed barriers to abortion. For example, women must receive biased counseling designed to deter them from having an abortion, and then wait 24 hours before the procedure. State health insurance offered in Georgia under the Affordable Care Act only covers abortion if the woman’s life is endangered or her health is severely compromised, and minors cannot obtain an abortion without notification of a parent. May 7, 2019: Planned Parenthood posted a press release titled: “In the Face of Extreme Abortion Bans Passing in States, Vermont Advocates Pass Historic Constitutional Amendment to Protect Abortion Access”. From the press release: Planned Parenthood of Northern New England (PPNNE) and Planned Parenthood Federation of America celebrate a major milestone toward the enactment of Prop 5, the constitutional amendment which would guarantee Vermonters the right to personal reproductive liberty. If approved, Vermont would become the first state in the country to explicitly protect reproductive freedom in its constitution. This proactive policy is part of a counter movement rising up from state advocates in response to the Trump agenda and Kavanaugh’s nomination to the U.S. Supreme Court, which puts abortion access on the line. New York’s Reproductive Health Act, passed earlier this year, marked the beginning of a sea change, in which half of states introduced policies that protect and expand access to safe, legal, abortion……The U.S. Supreme Court could overturn Roe v. Wade as soon as this year, and the ability to access safe, legal, abortion would be determined by the states. Women’s rights are at risk, and if Roe v. Wade is overturned, one in three women of reproductive age could live in a state where the right to abortion is not only overturned, but criminalized. Prop 5 would amend the Vermont Constitution to uphold the will of Vermonters – that an individual’s right to personal reproductive autonomy is central to liberty and dignity to determine one’s own life course.The process to pass a Vermont constitutional amendment has multiple provisions to ensure it reflects the will of the people. The amendment must pass both the Senate and the House Chambers in two consecutive legislative bienniums before being placed on the ballot for Vermont voters on Election Day in November 2022. Planned Parenthood looks forward to working with its partners to see this constitutional amendment through the entire process so that every person has the right to access safe, legal abortion when and where they need it…. The press release included a statement rom Dr. Leana Wen, President, Planned Parenthood Federation of America: “Today, Planned Parenthood celebrates the hard work of advocates in Vermont for working to enshrine reproductive liberty in the state’s constitution. This is history in the making. With Trump in the White House and Kavanaugh on the Supreme Court, it is more important than ever for states to enact proactive policies to create a critical backstop and protect access to safe, legal abortion care. We at Planned Parenthood commend reproductive health care champions for their leadership and their work to protect the lives and well-being of women and families in Vermont. When states can act to protect basic health care, they should, and Vermont is an example of the critical role state leaders can play in the work to preserve our patients’ rights and freedoms. May 7, 2019: CityBeat posted an article titled: “Ohio House Committee Holds Hearing on Bill Banning Insurance Coverage for Abortion”. It was written by Nick Swartsell. From the article: A bill that would prohibit most private insurance policies from covering abortion in Ohio had its first hearing in the Ohio House of Representatives Insurance Committee this morning.House Bill 182, co-sponsored by Clermont County State Rep. John Becker and State Rep Tom Brinkman of Cincinnati, both Republicans, would expand prohibitions already in place for insurance policies provided to public sector employees.Brinkman is the chair of the Insurance Committee. Eighteen other Republicans also have signed on as co-sponsors of the bill.Those who have healthcare due to their status as public employees, those enrolled in Medicaid and those who get their plans from the Affordable Care Act’s marketplace aren’t covered for abortions under current state law. Many women who have private insurance via their employers are covered for abortions, however……Today’s hearing was the first on the bill. Other lawmakers on the committee had several questions about the legislation – including whether it would impact contraception coverage and specific surgical procedures……The bill prohibits coverage of “drugs or devices used to prevent the implantation of a fertilized ovum” – a measure that critics say would prevent insurers from covering birth control measures like IUDs, the pill and others.Becker has said that the bill contains exceptions for certain life-threatening conditions, but critics took issues with his assertions.“An example of self-defense, related to this bill, would be the treatment of an ectopic pregnancy,” he said in written testimony last month. “This is also known as a tubal pregnancy. If not treated, the mother and child will both die. This is an example of a life of the mother exception.”Becker argues that an ectopic pregnancy – in which a fertilized egg exists inside a woman’s fallopian tube or other locations outside the uterus – could be addressed by removing the egg from the Fallopian tube and reinserting it into the womb. That’s not an actual medical procedure, critics say. Becker admits the technology that would allow that procedure is “in its infancy”, he told the media yesterday… May 8, 2019: Manchester Ink Link posted an article titled: “Soucy signs Family Leave Bill; House kills Casino Gambling, protects ACA”. It was written by Paula Tracy. From the article: …The House voted 213-137 in favor of SB 4, relative to the groups and individual health insurance market. This legislation would codify into state law protections for people with preexisting conditions and essential health benefits.Sen Feltes said: “With the Trump administration’s continued efforts to dismantle the Affordable Care Act, it is more important than ever for use to protect health care access for Granite Staters. Senate Democrats believe fair access to quality, affordable health care is not just a privilege for the few, but a right for all. That’s why we introduced SB 4, which will codify into state law protections for people with pre-existing conditions and essential health benefits, including maternity and newborn care, mental health and substance use disorder services, and prescription drugs… May 8, 2019: The U.S. Department of Health and Human Services posted information titled: “CMS Drug Pricing Transparency Fact Sheet”. From the information: …Right now, drug companies are required to disclose the major side effects a drug can have – but not the effect the drug could have on your wallet. Patients deserve more transparency, and this administration is committed to shining a light on what pharmaceutical companies have been hiding from patients.Drug companies will now be required to disclose to patients the list price for prescription drugs in TV ads.This final rule will require direct-to-consumer television advertisements for prescription drug and biological products covered by Medicare or Medicaid to include the list price – the Wholesale Acquisition Cost – if that price is equal to or greater than $35 for a month’s supply or the usual course of therapy, with the prices updated quarterly.The 10 most commonly advertised drugs have list prices fro $488 to $16,938 per month or usual course of therapy. Patients deserve to know what a drug costs as they discuss their options with their doctor.The final rule will go into effect 60 days after it was published in the Federal Register.If a manufacturer simply includes price information in a direct-to-consumer advertisement as required by § 403.1202, that information in the advertisement will not require review by the FDA Office of Prescription Drug Promotion (ODPD). ODPD does not review price information in prescription drug advertisements and does not intent to do so in the future, unless the price information explicitly or implicitly incorporates safety or efficacy information about the drug, or makes express or implied claims about the safety or efficacy of the drug… May 8, 2019: The American Medical Association posted a press release titled: “AMA: Trump administration requiring pricing information in TV drug ads”. It was written by Barbara L. McAneny, MD, President, American Medical Association. From the article: “The Trump Administration has taken a step in the right direction by requiring pricing information in direct-to-consumer television advertising of prescription drugs. Last year, the AMA called for regulations requiring the ads to include the manufacturer’s list price of those drugs, and we have supported similar legislative efforts. This small dose of transparency will help patients have a more complete picture when faced with prescription drug ads. While current ads outline the potential benefits and side effects, a crucial factor for patients – the drug’s price – is not included. Patients – especially those who pay a drug’s list price or whose cost-sharing is based on the list price – will now have another tool in their toolbox as they work with their physicians to determine their prescription drug regimes. That’s a notable change.” May 8, 2019: Senator Kristen Gillibrand posted an article on Medium titled: “Protecting reproductive rights requires a real, proactive agenda. Here’s mine.” From the Medium post: …So today, I want to expand on the rest of my reproductive rights platform. It’s made up of four key tenets:1 ACCESS: I will do everything in my power to protect access to safe, legal abortion.73% of Americans support Roe v. Wade, and women deserve a president who will protect their basic right to make personal health decisions. We have to reject politicians’ efforts to chip away at reproductive health access in Congress and in states across the country. I would end harmful policies like the Hyde Amendment, which disproportionately restricts access to abortion for low-income women and women of color. And I would repeal President Trump’s gag rule, because no politician should come between doctors and their patients.2 PREVENTION: I will protect access to health care that prevents unintended pregnancy.Let’s state the obvious: If politicians really wanted to decrease abortion rates, rather than just interfere in women’s lives, they’d get serious about defending and expanding access to birth control, guaranteeing sex education, and investing in – not gutting – Title X family planning funding. This is basic health care, and we won’t go backward on it.3 CARE: I will protect doctors and organizations that provide abortion – not defund, silence, criminalize or endanger them.The lies Donald Trump peddles about abortion providers put them and their patients in grave danger. We must put a stop to clinic violence by protecting doctors, nurses, and clinic workers who provide abortion care. And I will always protect funding for Planned Parenthood, a life-saving, necessary health care provider for millions of Americans.4 COURTS: I will protect the courts from being taken over by anti-choice extremists.As president, I will only nominate judges – including Supreme Court justices – who will commit to upholding Roe v. Wade as settled law and protect women’s reproductive rights… May 9, 2018: USA Today posted an article titled: “CDC: 1.1 million more Americans lost health insurance coverage in 2018”. It was written by Ken Alltucker. From the article: The number of Americans without health insurance increased again in 2018, the second consecutive year that figure has risen after several years of declines under Obamacare, a Centers for Disease Control and Prevention survey shows.About 30.4 million Americans did not have health insurance in 2018, up from 29.3 million in 2017, according to the CDC’s National Health Survey. That means about 1.1 million more Americans lost insurance coverage last year.Efforts by the Trump administration and Congress to challenge and loosen requirements of the Affordable Care Act probably played a role in some going without coverage, analysts said..…The Tax Cuts and Jobs Act of 2017 eliminated the health care law’s individual mandate that required people to get health insurance or pay a penalty. It formed the legal basis for a coalition of Republican-led states to argue in federal court that the entire health law should be tossed out – a challenge that the Trump administration supports……The CDC survey says the number of Americans in high-deductible plans reached an all-time high, covering 45.8% of people with private health insurance in 2018. In 2010, 25% of people with private coverage had high-deductible plans.A Gallup survey found that Americans borrowed $88 billion to pay for health care tase year, and one in four people skipped care because of cost……The CDC survey is based on data from 72,762 people who were asked whether they were insured.The uninsured rate among U.S. working-age adults was 13.3% in 2018, up from 12.8% in 2017. Among all ages, the uninsured rate was 9.4%, but the figure includes seniors on Medicare and children with Children’s Health Insurance Program coverage.Among 17 states with figures reported in the survey, Texas had the highest uninsured rates among working-age adults, 25%, and Massachusetts had the lowest, 4.9%… May 9, 2019: Georgetown University Health Policy Institute Center for Children and Families posted a report titled: “Medicaid Expansion Fills Gaps in Maternal Health Coverage Leading to Healthier Mothers and Babies”. From the report: Key Findings: New research shows states that expand Medicaid improve the health of women of childbearing age: increasing access to preventative care, reducing adverse health outcomes before, during and after pregnancies, and reducing maternal mortality rates.While more must be done, Medicaid expansion is an important means of addressing persistent racial disparities in maternal health and maternal mortality.Better health for women of childbearing age also means better health for their infants. States that have expanded Medicaid under the Affordable Care Act saw a 50 percent greater reduction in infant mortality than non-expansion states.The uninsured rate for women of childbearing age is nearly twice as high in states that have not expanded Medicaid, compared to those that have expanded Medicaid (16 percent v. 9 percentage). States with the highest uninsured rates for women of childbearing age are: Alabama, Alaska, Florida, Georgia, Idaho, Mississippi, Nevada, North Carolina, Oklahoma, South Carolina, Texas, and Wyoming. Ten of thise twelve states have not expanded Medicaid. Disruptions in health coverage are associated with adverse health consequences. This is especially true for women in their childbearing years, when a pregnancy means having health coverage is more important. The stakes are high as the care a woman receives during pregnancy is critical to her own health, as well as to the health of her newborn. In the United States, maternal and infant mortality is higher than most other industrialized nations, lending urgency to strategies to address the overall health of women.In this paper we review the substantial new research showing the significant improvements in access to health coverage for women of childbearing age achieved through the adoption of the Affordable Care Act’s (ACA) Medicaid expansion. Better health coverage is important not just for women who are pregnant but also for women well before they become pregnant and well after the childbirth. The American College of Obstetricians and Gynecologists (ACOG) recommends women have access to continuous health coverage in order to increase preventative care, reduce avoidable adverse obstetric and gynecologic health outcomes, increase early diagnosis of disease and reduce maternal mortality rates. Research also finds that Medicaid expansion has an important role in reducing the significant and persistent racial disparities in maternal and infant health. And finally, new studies show that healthier mothers mean healthier infants – another benefit for states that expand Medicaid… May 9, 2019: AL.com posted an article titled: After Georgia’s ‘heartbeat’ law, national abortion debate moves to Alabama”. From the article: …Sixteen states have passed or are scrambling to pass bans on abortion after a doctor can detect what they call “a fetal heartbeat in the womb,” usually about six weeks, before many women know they are pregnant. That includes Georgia, where Republican Gov. Brian Kemp signed a “heartbeat bill” into law on Tuesday.Separately, the Alabama Senate is poised to vote this week on legislation that could become the nation’s strictest abortion law, making it a felony to receive an abortion.In a countermove, lawmakers in a number of states are racing to amend state constitutions to provide a backstop for the possible overturn of Roe v. Wade, the 1973 Supreme Court ruling that legalized abortion.Vermont on Tuesday passed a bill that would enshrine abortion rights in the state constitution, with similar legislation in the works in 12 the states, including New Mexico, Nevada, and Rhode Island……The American Civil Liberties Union and other critics including medical lobbies have called bans on abortions after six weeks – which have been struck down by at least two courts – draconian, unscientific and part of a deliberate strategy to pass increasingly radical laws in hopes of getting the issue before the U.S. Supreme Court. They have vowed to bring a lawsuit targeting the legislation – and promised electoral payback as well……The ban passed by Alabama’s House last week intentionally excludes exceptions for victims of rape or incest to enhance its chances of getting to the Supreme Court, said Alabama state Rep. Terri Collins, R.The Alabama Judiciary Committee, however, on Wednesday adopted an amendment to allow abortions in cases of pregnancy by rape or incest. The amendment, by Sen. Tom Whatley, R-Auburn, was adopted on a voice vote.The full Senate will consider the amendment again when the bill reaches the Senate floor on Thursday.The law also criminalizes abortion, and doctors would face felony prison time of up to 99 years if convicted……Last month, Kansas Supreme Court ruled that the state’s constitution fundamentally protects abortion rights, blocking a state law that aimed to restrict a common procedure.At least nine states in addition to Kansas have constitutions that specifically protect a woman’s right to an abortion, according to state high court rulings: Alaska, California, Florida, Iowa, Massachusetts, Minnesota, Montana, New Jersey, and New Mexico. Other states including Connecticut, Delaware, Hawaii, Maine, Maryland, Nevada, New York, Oregon and Washington have statutory protection for abortion rights, according to the Center for Reproductive Rights.In January, New York lawmakers passed a law removing barriers for women seeking to get abortions later in pregnancy, and Virginia moved to do the same, sparking outrage from conservatives. May 9, 2019: The American College of Obstetricians and Gynecologists (ACOG) posted news titled: “ACOG Statement on Abortion Bans”. From the news: Ted Anderson, M.D., Ph.D., president of the American College of Obstetricians and Gynecologists (ACOG), issued the following statement in response to the many restrictions being placed on abortion access across the country:“ACOG strongly opposes political efforts to limit a woman’s ability to get the care she needs, including bans on abortion care. ACOG recognizes that abortion is an essential component of health care for millions of women and opposes political interference in health care. As the nation’s leading group of physicians providing health care for women, ACOG is dedicated to evidence-based and compassionate care.“Across the country, legislation is advancing restrictions that would impose professional, civil and even criminal penalties on physicians for providing safe, high-quality abortion care to their patients. These restrictions range from total bans to bans at arbitrary gestational ages, bans on the safest method of abortion after 12 weeks, bans based on a woman’s reason for seeking care, bans on medically-induced abortion via telemedicine, bans on physicians’ ability to exercise their best medical judgement according to their medical training, limits on which clinicians can preform abortion care, and more, Any of the restrictions would make safe and timely abortion care increasingly unavailable, which increases women’s health risks.“Lawmakers must support health policies based on sound science and evidence. Politicians must seek to improve access to care, not restrict it. Legislative restrictions fundamentally interfere with the patient-provider relationship and decrease access to necessary care for all women, and particularly for low-income women and those living long distances from health care providers. Health care decisions should be made jointly only by patients and their trusted health care professionals, not by politicians.” May 9, 2019: CityBeat posted an article titled: “Ohio Court Appeals Rules Embryos Are Not People in University Hospitals of Cleveland Case”. It was written by Preeya Shankar. From the article: The 8th District Ohio Court of Appeals has ruled that embryos are not entitled to personhood in a decision on a case brought against University Hospitals in Cleveland.The case came after a freezer malfunction caused the los of over 4,000 eggs and embryos in March 2018. UH has stated that the malfunction was not due to a “lack of care, negligence, or breach of duty by Defendants.”Rick and Wendy Penniman of Broadview Heights brought the case to Cuyahoga County Common Pleas Court. According to Judge Larry Jones, they argued “the life of a person begins at the moment of conception, declaring that the legal status of an embryo is that of a person” and requested “costs incurred herein.” Judge Stuart Friedman ruled in favor of UH, and the couple appealed.Last week, the appellate court ruled 2-1 with Friedman (since retired). Jones wrote the affirming opinion, and Judge Eileen Gallagher concurred.Judge Jones wrote that, while the term embryo is “not well-defined” under Ohio law, it was not capable of “independent survival” and therefore, “does not constitute ‘a distinct human entity'”……The ruling comes less than a month after Ohio passed the Heartbeat Bill, banning abortions as early as six weeks. The earliest fetal viability has been tentatively placed at 24 weeks, meaning that, while the appellate court has ruled that an embryo incapable of survival does not have the rights of a person, abortions are banned around 20 weeks before a fetus could (potentially) survive independently… May 9, 2019: CBS News posted an article titled: “Alabama could pass a near-total ban on abortion as soon as Tuesday”. It was written by Kate Smith. From the article: Alabama’s near-total abortion ban legislation — House Bill 313, the “Human Life Protection Act” — could be passed into law as soon as Tuesday. If it passes it would be the most restrictive ban on abortion since the Supreme Court decided to legalize and protect the procedure nationwide with its 1973 Roe v. Wade ruling.The bill provides no exceptions for rape or incest and classifies the procedure as a Class A felony in the state. That means a doctor caught performing abortions in Alabama would face up to 99 years in prison.The rape and incest cause was the subject of a fiery interaction on Thursday morning when Will Ainsworth, the Lieutenant Governor of Alabama, moved to reject an amendment that sought to include an exception for the two situations. Senate Majority Leader Bobby Singleton challenged the quick decision, leading to an angry exchange between the two politicians.If the amendment had been added, the bill would have gone back to the House for a vote, leading to a delay… May 9, 2019: Representative Suzanne Bonamici (Democrat – Oregon) posted a press release on her official website titled: “Maloney, Bonamici Introduce Legislation to Stop False Advertising in Women’s Healthcare Services”. From the press release: Congresswomen Carolyn B. Maloney (D-NY) and Suzanne Bonamici (D-OR) today reintroduced the Stop Deceptive Advertising for Women’s Healthcare Services Act to crack down on false advertising related to family planning and reproductive health services. This bill directs the Federal Trade Commission (FTC) to prohibit reproductive healthcare service providers, including fake women’s health centers, from using deceptive advertising to imply that they provide abortion services when they do not, or that they do not provide abortion services when they do.“No one should have to question that the person they are seeking medical advice from is actually a doctor or that information is accurate, objective, and complete,” said Congresswoman Maloney. “It is truly disgusting that women’s reproductive rights are being taken away from them by fake women’s health centers whose guiding principle is to mislead, misinform, and outright lie to pregnant women, all to dissuade them from exercising their constitutionally protected right to have an abortion. It is long past time that we prohibit these predatory tactics to undermine women’s reproductive health. This legislation simply requires the FTC to ensure honesty in advertising for anyone promoting healthcare services to women.”“Women must be able to trust their health care providers when making critical decisions about family planning and reproductive health,” said Congresswoman Bonamici. “Crisis pregnancy centers mislead women into thinking they provide comprehensive services, then limit women’s options by spreading misinformation about abortion. The mistruths and lies these centers spread can have devastating, long-term consequences for women and their families. This legislation will protect women by making sure crisis pregnancy centers cannot continue to advertise deceptive messages about the services they provide.”……Background: Fake women’s health centers, sometimes called crisis pregnancy centers (CPCs), are anti-choice advocacy organizations that pretend to be medically licenses reproductive healthcare providers in order to discourage pregnant women from having abortions. Staff at these clinics present themselves as medical professionals even though these centers do not have a single licensed doctor on site. Their deceptive tactics include disseminating inaccurate information, such as claims that abortion causes infertility. There are more than 4,000 fake women’s health centers nationwide; these centers outnumber legitimate reproductive healthcare clinics 3 to 1. May 9, 2019: Representative Carolyn Maloney tweeted a thread that started with this tweet: “No one should have to question that the person they’re seeking medical advice from is actually a dr or that info is accurate, objective & complete. Yet, fake women’s health centers, which pretend to be women’s repro health clinics, outnumber real clinics 3:1. Unacceptable (1/)” May 9, 2019: Representative Maloney’s thread continued with this tweet: “Fake women’s health centers’ guiding principle is to mislead, misinform, & outright lie to pregnant women, all to dissuade them from exercising their constitutionally protected right to have an abortion. It is long past time that we prohibit these predatory tactics (2/)” May 9, 2019: Representative Maloney’s thread concludes with this tweet: “That’s why today, I intro’d legislation with @RepBonamici to require the FTC to ensure honesty in advertising for anyone promoting healthcare services to women. Women’s #reprorights must be protected, not stolen from them by fake healthcare clinics (3/3).” The tweet included a link to the above press release. May 9, 2019: Representative Suzanne Bonamici tweeted a thread that started with this tweet: “Crisis pregnancy centers deceive women by misrepresenting that the centers will provide comprehensive services; then they limit women’s options by spreading misinformation about abortion.” The tweet included a link to the above press release. May 9, 2019: Representative Suzanne Bonamici’s thread concluded with this tweet: “I’m proud to lead legislation with @RepMaloney to end this deception & protect women.” May 9, 2019: The House Committee on Appropriations posted a press release titled: “Appropriations Committee Releases Fiscal Year 2020 State and Foreign Operations Funding Bill”. From the press release: The House Appropriations Committee today released a draft fiscal year 2020 State, Foreign Operations, and Related Programs funding bill, which will be considered in subcommittee on Friday, May 10. The legislation funds the Department of State, the United States Agency for International Development, and other programs and activities……”This bill reflects Congressional priorities to advance U.S. foreign policy and our foreign assistance programs,” said House Appropriations Subcommittee on State, Foreign Operations, and Related Programs Chairwoman Nita Lowey. “It rejects the Administration’s unacceptable, irresponsible FY2020 requests and reaffirms strong support for reproductive health, climate change, and multilateral assistance. This bill would make strong investments that would protect our national security and repair America’s global standing and commitments.”……Increases in funding for critical programs:Family Planning & UNFPA:$750 million for family planning – $175 million above the fiscal year 2019 enacted level and $513 million above the President’s budget request.$55.5 million for UNFPA – $23 million above fiscal year 2019 enacted level and $55.5 million above the President’s budget request.Other Global Health Programs:$2.616 billion for programs to improve maternal and child health and fight infectious diseases – $23 million above fiscal year 2019 enacted level and $818 million above the President’s budget request……President’s Emergency Plan for AIDS Relief (PEPFAR), including the Global Fund:5.93 billion for PEPFAR, including $1.56 billion for the Global Fund – $210 million above the fiscal year 2019 enacted level and $1.6 billion above the President’s budget request……Support for women’s reproductive rights:The House mark includes the GlobalHER Act, which would permanently repeal the Global Gag Rule, reinstated by President Trump in January 2017.It also includes a prohibition on current and prior funds from being used to implement the Mexico City Policy.The House does not include a prohibition carried in prior House bills on assistance to UNFPA.The House mark ends the exclusion of family planning from global health authorities and allows family planning products to benefit from the HIV/AIDS Working Capital Fund… May 9, 2019: Planned Parenthood posted a press release titled: “House Funding Bill Provisions Advance Reproductive Rights Across the Globe”. From the press release: Today, Planned Parenthood commends the U.S. House Committee on Appropriations for releasing a strong budget bill that increases funding and protections for reproductive health and rights across the globe. The FY 2020 State and Foreign Operations bill would increase U.S. funding for international family planning programs, restore and increase assistance to the United Nations Population Fund (UNFPA), and fully repeal the expanded and harmful global gag rule……The FY 2020 State and Foreign Operations bill includes:The Global HER Act, which would permanently repeal the global gag rule. It also blocks current or previous funding from being used to implement this harmful policy. President Trump vastly expanded the policy rule twice, which blocks international organizations from receiving any U.S. global health assistance if they provide, counsel, refer or advocate for abortion services – even if they are doing so with separate, non-U.S. funds, and even if abortion is legal in their country.Significant increase in funding ($175 million) for international family planning programs, which is a sound rejection of the Trump-Pence administration’s proposed extreme funding cuts.Restored and increased funding for the UNPFA, which provides reproductive and maternal health services in more than 150 countries in conflict and humanitarian settings… The Planned Parenthood statement included a statement from Dr. Leana Wen, President, Planned Parenthood Federation of America. “We applaud our reproductive health champions in Congress for taking action to restore funding and protections for the health and rights of individuals and families around the world. We know that when we invest in global health, we save lives, transform communities, and change the trajectory for generations to come.By repealing the global gag rule that plays politics with women’s lives, this bill will help ensure that people around the world can access life-saving services, like antiretrovirals, birth control, and even basic information about reproductive health care. It is time for Congress to end the Trump-Pence administration’s devastating global gag rule once and for all.” May 9, 2019: The American Medical Association posted a press release titled: “AMA pledges to help protect patients from surprise billing.” It was written by Barbara L. McAneny, MD, President, American Medical Association. From the press release: “We agree with the president that patients should not be responsible for coverage gaps and for any costs beyond their in-network cost sharing when they do not have an opportunity to choose an in-network physician. We also agree that physicians and hospitals should be transparent about their costs. In addition, insurers should be held accountable for their contributions to the problem and ensure network adequacy, adherence to the prudent layperson standard for emergency care in current law, and reasonable cost-sharing requirements.“Some of the principles raise more questions than answers, however. For instance, while the idea of a single bill sounds appealing, putting that into practice could have significant unintended consequences.“Solutions that policymakers adopt must incorporate network adequacy requirements to reduce the likelihood of unanticipated out-of-network care from the start. Policymakers must establish incentives to negotiate fair contracts and build adequate networks.“The AMA looks forward to working with the Administration and Congress. Our patients deserve a holistic solution that preserves access to affordable, high quality care.” May 10, 2019: The American Civil Liberties Union (ACLU) of Kentucky posted news titled: “Victory: Court Strikes Down D&E Abortion Ban”. From the news: On May 10, 2019, a federal district judge struck down a Kentucky law prohibiting physicians from providing dilation and evacuation (D&E), the standard method for abortion care after 14 or 15 weeks. Leading medical experts such as the American College of Obstetricians and oppose this type of restriction.Alexa Kolbi-Molinas, senior staff attorney with the ACLU Reproductive Freedom Project, released the following statement in response to the ruling:“Today’s ruling affirms that health, not politics, will guide important medical decisions about pregnancy. Laws like this are part of an orchestrated national strategy by anti-abortion politicians to push abortion out of reach entirely. Today’s decision holds – in no uncertain terms – that Kentuckians and the care they need come first.” May 10, 2019: National Organization of Women (NOW) posted a statement titled: “House FY2020 Bill Would Permanently Repeal Harmful Global Gag Rule, Increase Funding for Reproductive Health Internationally.” The statement is from NOW President Toni Van Pelt. From the statement: A new bill out of the U.S. House Committee on Appropriations would restore vital funding and protections for reproductive health and rights across the world and would finally repeal the devastating global gag rule, which President Trump has repeatedly expanded.The FY20 State, Foreign Operations bill advanced through the House subcommittee today and is expected go to the full Appropriations committee next week. The National Organization for Women strongly supports the proposed bill and urges the full committee to vote it through to the House floor.One of the first actions of the Trump-Pence administration was to expand the “global gag rule,” which prohibits international health care providers from giving women truthful information about their reproductive choices. And ever since the administration has continued to decimate international family planning programs, including slashing funding to the United Nations Population Fund, which provides lifesaving resources to millions of women and girls around the world.This appropriations bill includes the Global HER Act to repeal the global gag rule and rectifies these wrongs by restoring desperately-needed dollars to international reproductive health care programs. We urge the House to keep the momentum moving forward on this important bill. May 11, 2019: ABC News posted an article titled: “Federal judge strikes down Kentucky law to curtain 2nd-trimester abortions”. It was written by Soo Youn. From the article: A federal judge on Friday struck down a Kentucky law that would have effectively ended abortions after 15 weeks of pregnancy.U.S. District Judge Joseph H. McKinley Jr. ruled that the 2018 law, which required women seeking an abortion at or beyond 15 weeks of pregnancy to first undergo a “fetal demise” injection, was “unconstitutional.” He also missed a permanent injunction against the law.“The court finds that under the Act, all women seeking a second-trimester abortion at and after 15 weeks would have to endure a medically unnecessary and invasive procedure that may increase the duration of an otherwise one-day standard D&C abortion,” McKinley wrote.A Dilation and Evacuation (D&E) abortion is the standard second-trimester method of abortion used nationally.The law had been signed by Kentucky Governor Matt Bevin, a Republican, whose office immediately told the Associated Press it would appeal McKinley’s decision. His office did not immediately respond to an ABC News request for comment.The injection, which would kill the fetus, would not evacuate the fetus form the woman’s body, so an abortion would still be necessary. The law was challenged by the state’s only abortion clinic and two doctors — Ashlee Bergin and Tanya Franklin — who practice there, on the day it was signed……”The Commonwealth’s legitimate interests do not allow the imposition of an additional required medical procedure — an invasive and risky procedure without medical necessity or benefit to the woman — prior to the standard D&E abortion. Here, Kentucky’s legitimate interests must give way to the woman’s right,” McKinley wrote.Alexa Kolbi-Molinas, a lawyer with the American Civil Liberties Union who represented the abortion clinic and its doctors, praised the judge’s ruling… May 13, 2019: CBS News posted an article titled: “A pregnant 11-year-old rape victim in Ohio would no longer be allowed to have an abortion under new state law”. It was written by Kate Smith. From the article: An 11-year-old girl in Ohio was allegedly raped by a 26-year-old multiple times, leaving her pregnant, according to police reports. A state law passed in April, but not yet in effect, says that victims like her won’t have a choice to have an abortion – they would have to carry and deliver their rapist’s child.The new law prohibits women from obtaining an abortion after a fetal heartbeat is detected, about five or six weeks into a pregnancy, before most women even know that they’re pregnant.The law provides no exceptions for rape or incest……Though the 11-year-old in this case won’t be subject to the state’s pending law, thousands of other women in the future would be. More than 4,000 women were raped in Ohio in 2017, according to data compiled by the FBI. Of those, more than 800 victims were assaulted by a family member. In the future, if women became pregnant as a result of such crimes, Ohio’s so-called “fetal heartbeat bill” would prohibit them from receiving an abortion any time after about six weeks, which is before most women even know they’re pregnant……Ohio’s six-week ban isn’t slated to go into effect until July, but abortion rights advocates from the American Civil Liberties Union (ACLU) and the Center for Reproductive Rights have vowed to challenge it in court before them.Even though Ohio joins five other states that have passed their own six-week bans, none have been implemented. They either haven’t taken effect yet, as in Georgia and Ohio’s case, or they were blocked by a federal judge, like in Mississippi, Kentucky, Iowa, and North Dakota.Even with the law not yet implemented, the 11-year-old would face many obstacles if she did want to terminate her pregnancy, said Elizabeth Nash, a senior state issues manager at the Guttmacher Institute, a reproductive rights research organization. Prior to Ohio’s six-week ban, the state’s laws were already some of the most restrictive toward abortion access, according to data from Guttmacher. Abortions after 20 weeks into a pregnancy are prohibited in the state, and minors, like the 11-year-old rape victim, must obtain parental consent, or argue their case to a judge… May 13, 2019: Planned Parenthood posted a press release titled: “Trump-Pence Administration Blocks Women’s Access to Health Care During Women’s Health Week”. From the press release: National Women’s Health Week is May 12-18, 2019, recognized by the U.S. Department of Health and Human Services’ Office on Women’s Health with the goal of encouraging “all women to be as healthy as possible.”However, during this Women’s Health Week, the policies of the Trump-Pence administration continue to make it harder for women across the country to access health care, including affordable birth control and high-quality comprehensive sexual and reproductive health care……National Women’s Health Week should be a time to celebrate, protect, and expand women’s access to health care. Instead, across the country, political attacks on reproductive health care are skyrocketing. We’re seeing restrictions and outright bans on abortion; laws attempting to roll back access to birth control and cancer screenings; the Trump-Pence administration’s attempt to dismantle Title X, the nation’s dedicated program for affordable birth control and reproductive health care, with an illegal and unethical gag rule; and attempts to dismantle the Affordable Care Act and the Medicaid program.Attack on Title X:Since day one, the Trump-Pence administration has aggressively targeted the civil and human rights of people of color, people with low incomes, and women. Earlier this year, it released a final gag rule. The rule, if it goes into effect, would make it illegal for health care providers to tell their patients how or where they can access abortion, and includes restrictions aimed to block Title X patients from getting care at Planned Parenthood health centers – even though Planned Parenthood serves approximately 40 percent of Title X patients.Title X is the nation’s only federal program dedicated to affordable birth control and reproductive health care that four million people rely on each year. The program is meant to ensure that people who are struggling to make ends meet can still access health care like birth control, cancer screenings, STI testing and treatment, and annual exams. Nearly 50 percent of the Title X network has made it clear that the rule would force them out of program – the administration is putting health care at risk for patients across the country……HHS Refusal Rule:Earlier this month, the Trump-Pence administration released a final rule that would allow health care workers to put their beliefs ahead of people’s health by refusing to provide care or information to patients. If it takes effect, this dangerous rule puts patients’ health at risk, especially for women and LGBTQ people. In allowing doctors, nurses, and other health care providers to deny care to patients, the Trump-Pence administration is providing legal cover for discrimination. This will widen health care disparities and worsen health outcomes for those who already face too many barriers to care.People should be able to trust that they will be able to access the best medical care possible, instead of having to worry about whether or not they will get the right care or information because of their providers’ beliefs. The impact of this policy will be most harmful to women of color, who are more likely to live in areas with hospitals that claim an objection to comprehensive reproductive health care, including abortion and certain forms of birth control.It could also harm transgender women. We know that discrimination in health care also already prevents LGBTQ people from accessing care, and nearly one-third of transgender people surveyed said a doctor or health care provider refused to treat them due to their gender identity. The refusal rule is yet another part of the administration’s systematic attacks on health care and rights of people of color, LGBTQ people, and women.Lies About Abortion:President Trump is repeating lies about abortion – despite being called out again, and again, and again. His false claims about abortion later in pregnancy are designed to manipulate the public and embolden state politicians who are pushing a dangerous agenda in state after state.These lies are providing the cover for state politicians to pass abortion bans that harm women. Last week, Georgia became the fourth state this year, after Kentucky, Mississippi, and Ohio, to enact a ban on abortion before many people even know they are pregnant… May 13, 2019: Vox posted an article titled: “The House’s big bill to lower drug prices and shore up Obamacare, explained”. It was written by Dylan Scott. From the article: …House Democrats have packaged together a bunch of proposals to lower prescription drug costs and to reverse the Trump administration’s maneuvers to undermine the Affordable Care Act, and they are bringing them to the floor for a vote this week as one bill.Intentional or not, it’s a clever bit of legislating. The prescription drug provisions are generally bipartisan; several have gotten the endorsement of Sen. Chuck Grassley (R-IA). Democrats have paired those policies with a few proposals to shore up Obamacare:providing money for states to set up their own insurance marketplacesrestoring funding for ACA enrollment outreach and support cut by the Trump administrationrepealing President Donald Trump’s expansion of skimpy “short-term” insurance plans……1 The bill targets generic drug “parking”Right now, the first generic drug approved to compete with a brand-name product gets 180 days of market exclusivity before a second generic can come on the market. But sometimes, the first approved generic will “park” after approval – not actually taking the drug to the commercial market, thereby delaying the entry of a second or third generic drug. Research has shown prices to start to really come down once there are several generic drugs on the market, not just one.So the House bill tries to prevent “parking” by permitting the FDA to approve a second generic application before the first drug has gone on the market under select circumstances……2 The bill bans “pay-for-delay” agreementsThis is pretty straightforward: Sometimes, brand-name drug manufacturers will straight-up pay a generic manufacturer to delay the generic product from entering the market. The Federal Trade Commission has estimated that such deals increase spending on prescription drugs by $3.5 billion annually.The House bill would prohibit such arrangements, which both parties see as anti-competitive. This is one of the ideas that Grassley has supported on the Senate side.3 The bill makes it easier for generic manufacturers to get the materials from brand-name drug makersAnother hiccup in the generic drug pipeline is when brand-name manufacturers refuse to provide the materials that generic competitors need to produce their cheaper knockoff versions of the brand-name drug. You might hear wonks talk about REMS – a Risk Evaluation and Mitigation Strategy – which is the bureaucratic process brand-name companies use to block their generic competitors from getting the samples they require.The House bill would allow generic manufacturers to request the FDA to authorize them to obtain materials from the brand-name company, allow generic drug makers to sue in court for samples and the court would be allowed to award monetary damages to the generic company as a way to discourage brand-name companies from participating in anti-competitive behavior.This is another area of overlap with Republicans; Grassley has sponsored a similar bill with Democratic Sen. Amy Klobuchar… May 13, 2019: The Baltimore Sun posted an editorial titled: “Maryland makes more progress on Obamacare rates – but there’s more to do”. It was written by the Baltimore Sun Editorial Board. From the article: For the second year in a row, Marylanders who rely on the Obamacare exchange to buy health insurance have a chance to pay lower rates. The initial rate requests from CareFirst BlueCross BlueShield and Kaiser Permanente aren’t quite as dramatic as last year’s across-the-board reductions – prices for some kinds of policies may go up slightly, but the most popular one, CareFirst’s HMO, will decline by nearly 9 percent. That’s a far cry from the death spiral of ever-escalating prices leading to dwindling enrollment and still higher prices other states have seen. It’s a reflection of good policy choices and an ongoing commitment by both the Democratic General Assembly and Republican governor to make the Affordable Care Act work. But with the Trump administration’s continued hostility toward the ACA, the job here is far from done.Gov. Larry Hogan today signed a bill that could help. The Maryland Easy Enrollment Health Insurance Plan creates a check-box on state income tax returns for people who are uninsured to seek coverage. Sponsored by Del. Joseline Peña-Melnyk and Sen. Brian Feldman, it authorizes the comptroller to share information with the Health Benefits Exchange to determine eligibility for Medicaid and to automatically enroll Marylanders in the program. The exchange would contact others with information about private health plans and subsidies in hopes of getting them to enroll. It’s a novel approach – no other state has tried anything like it – so there’s no way to know how many of the state’s approximately 400,000 uninsured people will get coverage as a result.The bill sets up a commission to study effects and to make recommendations to strengthen it if necessary. We expect it will lend up where this bill initially started – with the need to create a state version of the individual mandate President Donald Trump and Republicans in Congress gutted their 2017 tax legislation……House Bill 258/Senate Bill 239 (also sponsored by Ms. Peña-Melnyk and Mr. Feldman) would fix that by extending the state premium tax (at a lower rate than the federal one) through 2023, whether the federal government collects its tax or not. The measure passed with a veto-proof majority (and a number of Republican votes, particularly in the Senate), but Governor Hogan has not said whether he will sign it, and the bill did not make the list today when he signed other measures into law.In that same category is a bill that would create a Prescription Drug Price Review board to evaluate the expense of particularly high-cost medications or those subject to big price increases. The board would be empowered to set a cap on the price state and local governments would pay for those medication. That bill has some Republican backing, too……We urge Governor Hogan to sign both… May 14, 2019: Reuters posted an article titled: “Alabama Senate bans nearly all abortions, including rape cases”. It was written by David Trotta. From the article: Alabama’s State Senate passed a bill on Tuesday to outlaw nearly all abortions, creating exceptions only to protect the mother’s health, as part of a multistage effort to have the U.S. Supreme Court reconsider a woman’s constitutional right to an abortion.The country’s strictest abortion bill was previously approved by the Alabama House of Representatives and will now go to Republican Governor Kay Ivey, who has withheld comment on whether or not she would sign but is generally a strong opponent of abortion.The law, which passed 25-6, would take effect six months after being signed by the governor, but is certain to face legal challenge from the American Civil Liberties Union and other groups which have vowed to sue.Legislation to restrict abortion rights has been introduced this year in 16 states, four of whose governors have signed bills banning abortion if an embryonic heartbeat can be detected.The Alabama bill goes farther, banning abortions at any time. Those performing abortions would be committing a felony, punishable by 10 to 99 years in prison, although a woman who receives an abortion would not be held criminally liable……Anti-abortion advocates know any laws they pass are certain to be challenged, and courts this year have blocked a restrictive Kentucky law and another in Iowa passed last year……Just this year, Georgia, Kentucky, Mississippi, and Ohio have outlawed abortion after a doctor can detect an embryonic heartbeat.Opponents call the “heartbeat” legislation a virtual ban because embryonic cardiac activity can be detected as early as six weeks, before a woman may be aware she is pregnant……All 27 Republican senators are men. May 14, 2019: The American Civil Liberties Union (ACLU) tweeted a thread that started with this tweet: “BREAKING: Alabama’s legislature just passed a law that criminalizes doctors and makes abortion illegal. Abortion is NOT a crime – it’s a constitutional right. We will sue to stop this law from ever taking effect.” May 14, 2019: The American Civil Liberties Union (ACLU) concluded their thread with this tweet: “PSA: Abortion is still legal in all 50 states. It’s true that states have passed laws trying to make abortion a crime, but we will sue in court to make sure none of those laws ever go into effect.” May 14, 2019: Planned Parenthood Southeast Advocates tweeted: “Alabama politicians just voted to reject any exceptions for rape and incest after seeing rape Alabama survivors in the gallery and hearing their stories. Let that sink in. #HB314 #alpolitics”. May 14, 2019: Leana Wen, M.D., president and CEO of Planned Parenthood tweeted: “This is the most extreme and dangerous policy since Roe vs. Wade, banning abortion at any point in pregnancy – going so far as to threaten doctors with life-in-prison. Doctors and public health leaders agree: the cost will be women’s lives.” The tweet includes a link to the Planned Parenthood Southeast Advocates tweet above. May 14, 2019: Senator Kristen Gillibrand tweeted a short thread that started with this tweet: “For politicians who claim to care so much about humanity, they don’t have much of it.” This tweet included a link to the Planned Parenthood Southeast Advocates tweet above. May 14, 2019: Senator Gillibrand’s thread concluded with this tweet: “Alabama. Georgia. Mississippi. Kentucky. Ohio. The assault on on reproductive rights is happening across the country, and we have to step up our fight to stop them. Together. We need to focus our attention and our efforts where the attacks start: in the states. Stay tuned.” May 14, 2019: The American Civil Liberties Union of Alabama tweeted a thread that began with this tweet: “Today’s decision from the Alabama Senate to pass an abortion ban with no exceptions for rape or incest shows how little they regard bodily autonomy. This bill punishes victims of rape and incest by further taking away control over their own bodies and forcing them to give birth.” May 14, 2019: The American Civil Liberties Union of Alabama continued the thread with this tweet: “While lawmakers could have spent time finding solutions to keep open rural hospitals, increase pay for teachers, and address the critical issues facing Alabama’s prison system, they decided to gamble with taxpayer dollars. #alpolitics #noban4alabama” May 14, 2019: The American Civil Liberties Union of Alabama continued the thread with this tweet: “The ACLU of Alabama along with the National @ACLU and @PPFA, will file a lawsuit to stop this unconstitutional ban and protect every woman’s right to make her own choice about her healthcare, her body, and her future. #alpolitics”. May 14, 2019: The American Civil Liberties Union of Alabama concluded their thread with this tweet: “PLEASE REMEMBER: This bill will not take effect anytime in the near future, and abortion will remain a safe, legal medical procedure at all clinics in Alabama. #mybodymychoice #HB314” May 14, 2019: National Organization For Women (NOW) posted a statement titled: “Alabama’s Abortion Ban is an Unconstitutional Violation of Women’s Rights”. The statement is from NOW President Toni Van Pelt. From the statement: The dangerous bill moving through Alabama’s legislature to ban abortion is a direct violation of Roe v. Wade. This unconstitutional measure would send women in the state back to the dark days of policymakers having control over their bodies, health and lives.NOW firmly believes that women have the constitutional right to safe, legal, affordable and accessible abortion care and we strongly oppose this bill and the other egregious pieces of legislation that extremist lawmakers are trying to pass in what they claim is an attempt to force the Supreme Court to overturn Roe. This is a transparent effort to drum up political support for anti-abortion candidates in upcoming elections and serves as a direct threat to women’s health, autonomy, and pursuit of happiness. We will not let it stand. May 14, 2019: Senator Kamala Harris tweeted: “Republican lawmakers in states like Louisiana, Alabama, and Missouri are actively working to eliminate women’s access to safe, legal abortion. It’s a direct effort to criminalize women for their health care decisions. This is unacceptable.” May 14, 2019: Senator Bernie Sanders tweeted: “What Alabama is doing is blatantly unconstitutional and disrespects the fundamental right a woman has to make decisions about her own body. I say to Gov. Ivey: Veto this cruel bill. Stop the attack on women’s rights.” The tweet included a link to the ThinkProgress article below. May 14, 2019: ThinkProgress posted an article titled: “Alabama Senate passes total abortion ban, punishing providers with up to 99 years in prison.” It was written by Amanda Michelle Gomez. From the article: The Alabama Senate voted 25 to 6 to pass a total abortion ban Tuesday night, making it a felony to terminate a pregnancy at any point and punishable up to 99 years in prison.After hours of debate, the male-dominated Senate sent the governor one of the most restrictive bills in the country. The abortion ban would take effect six months after the bill becomes law. Gov. Kay Ivey (R) has not said whether she will sign the measure.Alabama’s extreme legislation comes just one week after Georgia Gov. Brian Kemp (R) signed a near-total abortion ban into law, banning abortion after six weeks of pregnancy, beginning in 2020. Both measures are intended as a challenge to Roe v. Wade, the 1973 Supreme Court decision that established the constitutional right to abortion……Unlike other GOP-controlled states, where lawmakers have limited access by banning a type of procedure or banning abortion up to a specific gestational age of the fetus, Alabama’s bill is a total ban. Under Alabama’s ban, providers could face jail time of 10 to 99 years for providing abortions. Patients are exempt from criminal and civil charges.The only exception is if the health of the pregnant woman or gender minority is at serious risk. But the possibility of jail time makes it unlikely that providers will perform any abortions no matter what the bill says, advocates warn……After much debate, lawmakers decided against adding an exception for rape or incest to the bill, in a 21 to 11 vote. The Democrat who introduced the amendment, Bobby Singleton, got emotional about the amendment failing……Advocacy groups are likely to challenge Alabama’s ban, which doesn’t concern lawmakers who voted for it. Indeed, the lawmaker who sponsored the bill hopes such a lawsuit is taken up by the Supreme Court, where conservative justices will eliminate the constitutional right to abortion… May 14, 2019: Laura Bassett (a reporter with bylines in The Washington Post, HuffPost, InStyle, and The Daily Beast) posted a thread that started with this tweet: “The amendment to add rape and incest exceptions failed 11-22. Alabama will make abortions a felony, in all cases, from the moment of conception, punishable by up to 99 years in prison.” May 14, 2019: Laura Bassett concluded her thread with this tweet: “There is no punishment in this bill for the man doing the impregnating, except presumably the obligation to pay child support in some cases.” May 14, 2019: Senator Elizabeth Warren tweeted: “This ban is dangerous and exceptionally cruel – and the bill’s authors want to use it to overturn Roe v. Wade. I’ve lived in that America and let me tell you: We are not going back – not now, not ever. We will fight this. And we will win.” The tweet includes a link to an article from The New York Times titled “Alabama Lawmakers Vote to Effectively Ban Abortion in the State”. (It is behind a paywall). May 14, 2019: Martina Navratilova (tennis player) tweeted: “Alabama Senate passes nation’s most restrictive abortion law – Those fuckers!!! And this is the very first time I used this word in almost 100.000 tweets and retweets… Even in the case or RAPE or INCEST!!!” The tweet included a link to an article from The Washington Post titled: “Ala. Senate votes to ban virtually all abortions.” (It is behind a paywall). May 14, 2019: Dr. Jennifer Gunter, a gynecologist, tweeted: “By making all abortion illegal and something that women will be arrested for, Alabama basically ensured women will not get medical care post botched abortion. Deaths will be unknown cause. So no spike in abortion deaths.” May 14, 2019: Representative Eric Swalwell tweeted: “The Trump-era rollback of women’s rights continues. We must turn this around. Every woman has the right to make her own medical decisions without government getting in the way.” The tweet includes a link to a CNN article titled: “Alabama Senate passes near-total abortion ban.” May 14, 2019: The Hill posted an article titled: “Ohio lawmakers consider requiring doctors to inform patients of controversial ‘abortion reversal'”. It was written by Jessica Campisi. From the article: A group of Republican lawmakers in Ohio plan to introduce a bill that would require doctors to tell women seeking medical abortions about a reversal procedure. The Abortion Reversal Information Act would mandate that all doctors prescribing abortion-inducting medications tell their patients they’re able to revers the procedure should they change their mind.”……Under an abortion reversal procedure, a woman takes two pills 24 to 48 hours apart. The first drug, mifepristone, is said to cause the death of the embryo and blocks the effects of progesterone, a hormone that helps the fetus develop. The second medication, misoprostol, is said to spur the removal of the embryo from the uterus, according to the American Pregnancy Association……Ohio Right to Life, an anti-abortion organization, has already states its support of the proposal, but the American College of Obstetricians and Gynecologists and NARAL Pro-Choice Ohio have cast doubt on abortion-reversal treatments, saying they’re not backed by science and are not recommended……The Food and Drug Administration hasn’t tested whether medically induced abortions can be reversed, according to the Guttmacher Institute, a research organization focused on sexual and reproductive health. May 14, 2019: Detroit Free Press posted an article titled: “Republicans in House, Senate pass anti-abortion bills after emotional debate”. It was written by Kathleen Gray and Paul Egan. From the article: The GOP-led Legislature’s straight party line votes on Tuesday to ban an abortion procedure performed in the second trimester, sets up a promised veto from Gov. Gretchen Whitmer – and an expected ballot proposal to get around the governor’s move from Michigan Right to Life.Republicans in the state Senate and House of Representatives passed the bills seeking to criminalize the dilation and evacuation procedure amid a national trend of GOP-led legislatures trying to restrict access to abortion as the U.S. Supreme Court grows more conservative……The House and Senate bill – HB 4320-4321 and SB 229-230 – would ban dilation and evacuation abortions, and would include criminal sentences for doctors who perform them of two years in prison. The vote – 22-16 in the Senate and 58-51 in the House with all Republicans supporting and Democrats opposing – came after emotional testimony on both sides of the issue……But Democrats told stories of women who faced the incredibly difficult decision to end wanted pregnancies because of severe medical issues of the fetus and said that dilation and evacuation often was the safest option for women……Sen. Erika Gress, D-Taylor, said government should not be interfering in the decisions made by women and their doctors……And Rep. Lori Stone, D-Warren, said that banning the procedure would be risking the future fertility of women……Even though the bills got some support from all legislative Republicans, it probably won’t become law in Michigan, at least in the near future.Gov. Gretchen Whitmer, an East Lansing Democrat, has pledged to veto any bills that restrict access to abortion……In Michigan, four additional anti-abortion bills have been introduced so far this year:SB 165: Would ban abortions past 20 weeks and impose sanctions of up to 15 years in prison and a $7,500 fine for doctors performing the procedure.HB 4332: Would prohibit the state from contracting for services with any agency that provides abortions.HB 4416-4417: Would require more reporting requirements to the state from abortion providers, including extensive reports from a medical examiner or any person with knowledge of a woman who has experienced medical complications or died after having an abortion.Conversely, another six bills – SB 50, 52-53, and HB 4113, 4115-4116 – from abortion rights supporters in the state House and Senate have been introduced that would repeal the 1931 law that makes abortion illegal in Michigan.These bills have been introduced to ensure that abortion remains legal and available in Michigan if the U.S. Supreme Court overturns Roe v. Wade. But they are not expected to get a hearing or a vote in the Republican-controlled Legislature… May 14, 2019: Star Tribune posted an article titled: “‘Heartbeat’ abortion ban to be debated in the Senate”. From the article: Missouri’s Republican-led Senate is set to take up a bill to ban abortions after eight weeks, a move that comes as GOP legislatures across the U.S. are emboldened by the possibility that a more conservative Supreme Court could overturn its landmark ruling legalizing the procedure.The Missouri bill would be one of the nation’s most restrictive if enacted. It’s similar to “heartbeat” bills signed into law in Mississippi, Kentucky, Ohio and Georgia that ban abortion once a fetal heartbeat is detected. That can occur in about the sixth week of pregnancy.Missouri is among several states where abortion opponents are working with renewed enthusiasms following President Donald Trump’s appointment of more conservative high court justices……Missouri’s bill also includes an outright ban on abortions except in cases of medical emergencies. But that would only kick in if Roe v. Wade is overturned.Doctors who perform abortions in Missouri would face 5-15 years in prison if that provision is enacted.The Missouri legislation is designed to withstand court challenges, which are likely imminent……If courts don’t allow Missouri’s proposed eight-week ban to take effect, it includes a ladder of less-restrictive time limits ranging from 14-20 weeks.Other provisions in the wide-ranging abortion bill include a ban on abortions based on race, sex or a “prenatal diagnosis, test, or screening indicating Down Syndrome or the potential of Down Syndrome in an unborn child.”The bill would also require that both parents be notified in order for a minor to get an abortion, with exceptions. Current law only requires written consent from one parent… May 14, 2019: WPRI 12 Eyewitness News posted an article titled: “Abortion bill rejected by RI Senate committee”. It was written by Steph Machado. From the article: The Senate Judiciary Committee voted Tuesday to reject a high-profile bill that would codify the right to an abortion in state law, dealing a significant setback to activists just months after they managed to get the measure through the House.The Senate panel voted 5-4 against the Reproductive Health Care Act, sponsored by Sen. Gayle Goldin, D-Providence. The move was widely expected after the panel’s most likely swing vote, Democratic Sen. Stephen Archambault, announced late Monday he could not support the bill as written. He said Goldin rejected his proposal for alternative language that would be more limited.However, the committee also voted to hold the House’s companion abortion bill for further study rather than defeat that, too – leaving open a path to return to the issue later in the session. Nevertheless, angry activists erupted in protests immediately after the hearing, even occupying the Senate chamber……Senate Judiciary Committee Chairwoman Erin Lynch Prata, a Warwick Democrat who voted in favor of the bill, expressed frustration that her chamber was presented with a fait accompli after the House passed its own abortion measure, the Reproductive Privacy Act, back in March……However, the five lead sponsors of the House bill said in a joint statement Tuesday evening they were “very disappointed” in the Senate and gave no indication House leaders are open to changes… May 14, 2019: NARAL Pro-Choice Ohio posted a press release titled: “Abortion Pill Reversal is Fake Medicine”. From the press release: Columbus – Sen. Peggy Lehner and Rep. Niraj Antani will both be sponsoring legislation to support the mythical concept of “abortion pill reversal.” Just as with Rep. Becker’s House Bill 182, this newly proposed bill is making up medical procedures.NARAL Pro-Choice Ohio Executive Director Kellie Copeland said: “Abortion opponents in Ohio have accelerated their efforts to stigmatize abortion with medically-inaccurate information and unproven practices. Abortion providers rely on scientifically accurate and thoroughly researched information to support patients before, during, and after an abortion. Rep. Antani and Sen. Lehner are trying to mislead patients and discredit abortion providers. Patients need medically accurate information, not scripts dictated by politicians filled with deception and ideologically-driven claims.”She continued, “It’s bad enough that uninformed extremists in the Ohio Statehouse are pushing the mythical medical concepts, but Mike Gonidakis, a member of Ohio’s State Medical Board (and leader of Ohio Right to Life) is also peddling this nonsense. Ohio is in serious danger of losing its reputation as a medical leader in the U.S.”Additional background:The American Congress of Obstetricians and Gynecologists (ACOG) does not recommend the practice, stating that “claims regarding abortion ‘reversal’ are not based on science and do not meet clinical standards… and ACOG does not support prescribing progesterone to stop a medical abortion.”A medication abortion involves the use of two drugs, mifepristone and misoprostol, and has been found to be an effective and safe way to end a pregnancy, as documented in the 2018 report, “The Safety and Quality of Abortion Care in the United States.” Mifepristone blocks progesterone, a crucial hormone for maintaining a pregnancy. Taken by itself, mifepristone may not be successful at ending a pregnancy, which is why the second pill, misoprostol, is given. Anti-choice groups claim that by flooding the body with progesterone they can interrupt the effect of mifepristone. However, claims of the safety and efficacy of this practice are not supported by scientific evidence. May 14, 2019: The Sacramento Bee posted an article titled: “It’s time to get the votes. Gavin Newsom hits the road to promote his health care ideas”. It was written by Hector Amezcua. From the article: …As the deadline to strike a budget deal approaches, Gov. Gavin Newsom is launching a statewide tour to promote his plans to shore up Obamacare and expand state health coverage to young undocumented adults. The tour underscores the emphasis Newsom is placing on the health care elements of his budget. It also highlights the potential challenge the Democratic governor faces in getting the Legislature to back his proposals……Newsom will also visit San Francisco, Los Angeles and San Diego during the five-day tour.Newsom’s proposal to reinstate the individual mandate, which the federal government rolled back after President Donald Trump took office, is perhaps his most direct attempt to prop up the Affordable Care Act. But it will require lawmakers to vote to penalize constituents who don’t have insurance, one of several taxes and fees Newsom wants to enact to support his budget proposal.But without a way to maintain a large pool of people who pay for insurance, Newsom says insurance prices will go up for everyone……Newsom wants to use money generated by the individual mandate to increase subsidies for people making up to 600 percent of the federal poverty level – about $150,000 for a family of four.Throughout the week, Newsom will also promote his plans to consolidate the state’s drug price negotiations and spend $100 million on reproductive and sexual health care… May 14, 2019: NARAL Pro-Choice America posted a press release titled: “NARAL Condemns Alabama’s Abortion Ban Following Passage of Extreme Legislation by Alabama Senate”. From the press release: The Alabama Senate voted today to pass a bill that is effectively a total ban on abortion, criminalizing abortion at any stage of pregnancy and threatening doctors with up to 99 years in prison for providing abortion care to their patients. In response, NARAL Pro-Choice America President Ilyse Hogue issued the following statement:“Alabama just passed a law that is a total ban on abortion, criminalizing the act and punishing woman and doctors. Anti-choice Republicans no longer even pretend to respect the law or the women it protects. When this dangerous and demeaning law was passed, Republicans stood up and applauded, while women wept. The Lt. Governor stated explicitly that this law is designed to overturn Roe v Wade, as they capitalize on securing an anti-choice majority on the Supreme Court.“When women stood up in record numbers to fight Kavanaugh’s nomination, propelled by his alarming record and Trump’s promise to nominate jurists committed to criminalizing abortion and punishing women, we were told we were ‘hysterical’ because Roe was settled law. Not six months later, we are battling measures where the stated goal is exactly that: outlawing abortion. It’s time to listen to women, not punish us for trying to make critical decisions about our own families and our own lives.”The passage of Alabama’s ban on abortion is set against the backdrop of a string of extreme bans on abortion introduced, passed or signed into law in over a dozen statehouses across the country this year alone. In Alabama, the bill’s sponsor made clear their aims, saying: “it’s very simple, it simply criminalizes abortion.”The bill’s intent was always to punish women and restrict control over their own lives, bodies, and futures. This bill is so extreme that its drafters did not even include an exception to allow survivors of rape and incest to access abortion care. May 15, 2019: CBS News posted an article titled: “Alabama governor signs near-total abortion ban”. It was written by Kate Smith. From the article: Alabama Gov. Kay Ivey just signed the state’s controversial near-total abortion ban. The new law is the most restrictive anti-abortion measure passed in the United States since Roe v. Wade was decided in 1973. The legislation – House Bill 314, “Human Life Protection Act” – bans all abortions in the state except when “abortion is necessary in order to prevent a serious health risk” to the woman, according to the bill’s text. It criminalizes the procedure, reclassifying abortion as a Class A felony, punishable by up to 99 years in prison for doctors. Attempted abortions will be reclassified as a Class C penalty.The legislation makes no exceptions for victims of rape or incest… May 15, 2019: Charlotte Clymer tweeted: “Let me be absolutely clear: Gov. Kay Ivey does not give a single damn about the welfare of children in her state. If she did, she’d be leading the way in turning around Alabama’s atrocious record on everything from its infant mortality rate to child poverty. #AlabamaAbortionBan” May 15, 2019: Charlotte Clymer tweeted: “Alabama is ranked: #37 in child and teen death rate #39 in teen births #42 in children concentrated in high poverty areas #46 in child poverty overall #47 in public health #50 in education This ain’t adding up with your statement, @GovernorKayIvey #AlabamaAbortionBan” May 15, 2019: American Civil Liberties Union Alabama posted a comment titled: “ACLU of Alabama Comment on Governor Ivy Signing HB314”. From the comment: Less than 24 hours after the Alabama Senate passed HB314, the nation’s most restrictive ban on abortion that includes no exceptions for rape or incest, Governor Ivey has signed this legislation. According to the language in the bill, this ban does not go into effect until 6 months after it has been signed.Randall Marshall, Executive Director of ACLU of Alabama:“By signing this bill, the governor and her colleagues in the state legislature have decided to waste millions in Alabama taxpayer dollars in order to defend a bill that is simply a political effort to overturn 46 years of president that has followed the Supreme Court’s Roe v. Wade decision. We will not allow that to happen, and we will see them in court.Despite the governor signing this bill, clinics will remain open, and abortion is still a safe, legal medical procedure at all clinics in Alabama.” May 15, 2019: Senator Bernie Sanders tweeted: “In no state in America does support for a total ban on abortion – like Alabama just passed – reach even 25%. The extremist attacks on abortion rights must end. #AlabamaAbortionBan”. May 15, 2019: Leana Wen, M.D., President & CEO of Planned Parenthood tweeted: “To patients seeking abortion care in Alabama: this law hasn’t gone into effect yet – and we will make sure of it. #AlabamaAbortionBan #WomensRightsAreHumanRights” May 15, 2019: Planned Parenthood Action tweeted: “Reminder: 73% of Americans don’t want to see #RoeVWade overturned.” May 15, 2019: Cecile Richards tweeted: “The bill that was passed in Alabama is an all-out abortion ban. But make no mistake: Women across the country see what is happening, and they are going to be the deciding voters in the 2020 election.” May 15, 2019: Senator Tammy Duckworth tweeted: “The extreme #AlabamaAbortionBan would throw doctors in jail for up to 99 years silly for providing medical care. That’s horrific and it puts politics ahead of women’s health. A woman’s medical decision should be between her and her physician, NOT dictated by politicians.” May 15, 2019: Senator Tammy Duckworth tweeted: “The #AlabamaAbortionBan would endanger women’s lives and re-victimize survivors of sexual violence. Politicians in Washington and the #AlabamaSenate do NOT know better than women and their doctors. We must oppose the coordinated assaults on women’s freedoms + healthcare.” May 15, 2019: Senator Patty Murray tweeted: “The #AlabamaAbortionBan is part of a larger effort across the country to allow politicians to make decisions for women about their bodies, their health, and their lives. To all the women reading the news today – know I will keep fighting for you ever step of the way.” The tweet included a short video of Senator Patty Murray speaking. May 15, 2019: Center for Reproductive Rights posted a statement titled: “Statement: Alabama’s Unconstitutional Ban on Abortion”. From the statement: Statement by Nancy Northup, President and CEO of the Center for Reproductive Rights, on Governor Kay Ivey signing House Bill 314 into law:“All who care about women should be alarmed by the callousness and extremism of politicians who seek to deny women the ability to make decisions about their reproductive health and lives. Alabama’s criminal abortion ban, and all other affronts to Roe v. Wade, will be challenged and blocked in the courts. The Supreme Court has upheld the core protections for women’s reproductive decision-making for almost 50 years, and the integrity of the Court and the lives of women depend on its following settled law and rejecting these cruel attempts to upend our constitutional rights.” May 15, 2019: NARAL Pro-Choice America tweeted: “Anti-choice politicians across the U.S. are working overtime to pass extreme bans on abortion that are designed to roll back Roe v. Wade. But for now, Roe stands – and you can count on us to fight like hell to keep it that way. #AlabamaAbortionBan” The tweet included an image of the United States with the words “Abortion is still legal in ALL 50 STATES” May 15, 2019: Center for Reproductive Rights tweeted: “#AlabamaAbortionBan is the number one trending topic on Twitter right now. Also on the list is #WomansRightsAreHumanRights and #AbortionRights. It’s clear what the American people want.” May 15, 2019: Lady Gaga tweeted: “#AlabamaAbortionBan #Alabama #AlabamaSenate #NoUterusNoOpinion #PlannedParenthood #ProChoice I love you Alabama prayers to all women and young girls here are my thoughts:” The tweet included an image with the following words: “It is an outrage to ban abortion in Alabama period, and all the more heinous that it excludes those who have been raped or are experiencing incest non-consensual or not. So there’s a higher penalty for doctors who perform these operations than for most rapists? This is a travesty and I pray for all these women and young girls who will suffer at the hands of this system.” May 15, 2019: Andrew Yang posted a thread of tweets that started with this tweet: “The Alabama law banning and criminalizing abortion even in cases of rape or incest is a dramatic step in the wrong direction. Government should not be making decisions on behalf of women. I would protect women’s right to choose. May 15, 2019: Andrew Yang continued his thread with another tweet: “$1,000 a month for each individual would help society become stronger. It would help many Americans decide to have and keep children. One person said to me that the Freedom Dividend is the most pro-life policy being considered in our country.” May 15, 2019: Andrew Yang concluded his thread with this tweet: “I personally don’t think male legislators should be weighing in on women’s reproductive rights and freedoms. It should be up to the woman. I’m happy to let women decide for themselves.” May 15, 2019: Senator Cory Booker posted a thread that started with this tweet: “The Alabama abortion ban is part of a coordinated, all-out effort to erode women’s reproductive rights and freedom nationwide. But let me be clear: Women shouldn’t have to face this fight alone.” The tweet includes an image that says “Abortion is Health Care.” May 15, 2019: Senator Cory Booker continued his thread with this tweet: “Men, it is on us to speak out too. It’s on us to take action. Not because women are our mothers, wives, daughters. Because women are people. And all people deserve to control their own bodies.” May 15, 2019: SenatorCory Booker concluded his thread with this tweet: “We must pass federal laws to protect women’s rights. We need to codify Roe v. Wade into law and fully fund Planned Parenthood. We must repeal the Hyde Amendment.” May 15, 2019: Governor of Washington Jay Inslee posted a short thread that started with this tweet: “The #AlabamaAbortionBan is still unconstitutional, signed or not. This fight is far from over.” The tweet included an article fro, HuffPost. May 15, 2019: Governor of Washington Jay Inslee concluded his thread with this tweet: “In Washington, we have protected and expanded reproductive freedom. Women across the country deserve the same. We can’t stand by while Republicans try to turn back the clock on women’s health. #WomensRightsAreHumanRights”. May 15, 2019: Senator Kirsten Gillibrand tweeted: “This is exactly why I made a promise only to appoint judges and justices who will commit to upholding Roe v. Wade. This isn’t a matter of “what if” anymore; our rights are under attack, and our response is either head-on or it’s not enough. I’m ready to fight.” The tweet included a short video of her speaking on NBC News, in reference to Alabama’s abortion bill. May 15, 2019: Reason posted a blog titled: “Abortion Ban in Alabama Designed ‘To Directly Challenge Roe v. Wade;”. It was written by Elizabeth Nolan Brown. From the article: …That bill passed the Alabama Senate 25-6 yesterday, without the rape/incest exceptions (which failed 21-11).It not only bans abortion at any point in pregnancy but also makes it a felony for doctors to perform them, with exceptions only when the mother’s life is in danger……Bill sponsor Sen. Clyde Chambliss, a Republican, specified that the law would not prohibit the destruction of fertilized eggs used for in-vitro fertilization, only those conceived within a woman’s body. “The egg in the lab doesn’t apply. Its not in a woman. She’s not pregnant,” Chambliss said, in a floor debate with Democratic Sen. Rodger Smitherman… May 15, 2019: Sunlight Foundation posted an article titled: “New report analyzes how the administration is undermining the Affordable Care Act using web censorship”. It was written by Rachel Bergman. From the article: …Our new trend report, “Erasing the Affordable Care Act: Using Government Web Censorship to Undermine the Law,” explores the current administration’s censorship of ACA-related web content to show that loose regulation and federal government websites allows an administration to use them to weaken laws it opposes. The Web Integrity Project has documented 26 instances of ACA censorship – including excised words, removed links, altered paragraphs, and removed pages – on HHS websites. These examples of censorship are unlikely to be all of the instances of ACA-related censorship on federal websites, and may represent only a small sample of the censorship that has occurred since President Trump took office.HHS offices hav censored a wide array of content aimed at a variety of audiences, including the general public, beneficiaries, and those who serve beneficiaries. They’ve surgically removed the term “Affordable Care Act: from many webpages; taken down information on rights guaranteed under the ACA; eliminated statistics and data on the ACA’s impact; and removed links to the federal government’s main platform for enrolling in ACA coverage, HealthCare.gov. If repeated on a wide scale, these forms of censorship of the ACA information on federal websites have the potential to affect public support and awareness of the law. Ultimately, censorship that affects public opinion and awareness of the ACA may jeopardize Americans’ access to coverage and health services, and down the line, the ACA’s long-term viability……What’s more, censoring online information about rights, benefits, and services under the ACA may have an outsized negative impact on the most vulnerable in our society. Many instances of web censorship we have seen have targeted information and resources for underserved populations like women, the LGBTQ community, minority groups, and people with a mental health condition, and in some cases may deepen the negative impacts of policy changes that de-emphasize and de-prioritize their rights to affordable coverage. These communities are already more likely to be uninsured or have less access to ACA health services than the rest of the population… The 26 findings documented in the report (liked above) are: Remove of link to HealthCare.gov from the footer of HHS.gov’s ACF website.Changes in language and removals of descriptive text that emphasized the positive impact of the Affordable Care Act on the ASPE websiteRemoval of references to the Affordable Care Act from CDC.gov’s “National Center for Health Statistics” webpagesRemoved link to HealthCare.gov from header of CMS.govRemoval of references to the Affordable Care Act from a CMS.gov webpage about the National Health ExpenditureRemoval of reference to the Affordable Care Act from CMS.gov’s “Hospital-Acquired Condition Reduction Program (HACRP)” webpageRemoval of the “Marketplace Outreach: Best Practices for Outreach to Latino Communities” PDF from CMS’s Health Insurance Marketplace websiteRemoval of slides from “Tips for FFM Assisters on Working with Outside Organizations” presentation on CMS’s Health Insurance Marketplace websiteOverhaul of HealthCare.gov’s “Apply for Health Insurance” webpageRemoval of “Affordable Care Act” as an FAQ category on HHS.govRemoval of references of the Affordable Care Act on HHS.gov’s “Who is eligible for Medicaid?” webpageAlterations to “About the ACA” webpages on HHS.gov’s “Healthcare” websiteRemoval of “Facts and Features” website from HHS.govRemoval of references to the Affordable Care Act from HRSA’s “About the Office of Women’s Health” webpageRemoval of reference to Medicaid, CHIP, and the Health Insurance Marketplace from HSRA’s strategic goalsRemoval of the Affordable Care Act website from within Medicaid.govRemoval of reference to the Affordable Care Act from Medicaid.gov’s “Medicaid and CHIP Eligibility Levels” webpageRemoval of the “Affordable Care Act & Medicare” webpage and corresponding links from the Medicare websiteRemoval of questions and infographic about the Affordable Care Act on MentalHealth.govLanguage removals pertaining to sex discrimination from HHS’s Office of Civil Rights webpages about Section 1557 of the Affordable Care ActRemoval of pages, references, and links pertaining to the Affordable Care Act from the Office of Minority Health websiteRemoval of references to the Affordable Care Act from the Office of Minority Health “History of the Office of Minority Health” webpageRemoval of a collection of webpage related to the Affordable Care Act from the Office of Population Affairs websiteRemoval of Breast Cancer website and related webpages from within the Office on Women’s Health websiteRemoval of “Affordable Care Act” from “Vision, mission, goals and history” webpage on the Office of Women’s Health websiteRemoval of references to the Affordable Care Act from Office on the Women’s Health “Heart-healthy eating” webpage May 16, 2019: ABC News posted an article titled: “Missouri Senate passes bill to ban abortions at 8 weeks”. It was written by Summer Ballentine. From the article: Missouri’s Republican-led Senate has now passed a bill to ban abortions at eight weeks of pregnancy.Senators approved the legislation 24-10 early Thursday with just hours left before a Friday deadline to pass bills. It needs at least one more vote of approval in the GOP-led House before it can go to Republican Gov. Mike Parson, who voiced support for it on Wednesday.Parson called on state senators to take action, joining a movement of GOP-dominated state legislatures emboldened by the possibility that a more conservative Supreme Court could overturn its landmark ruling legalizing the procedure. Their vote came only hours after Alabama’s governor signed the most stringent abortion ban in the nation on Wednesday, making performing an abortion a felony in nearly all cases.The Missouri proposal includes exceptions for medical emergencies, but not for pregnancies caused by rape or incest. Doctors would face 15 years in prison for violating the eight-week cutoff. Women who receive abortions at eight weeks or later into a pregnancy wouldn’t be prosecuted.Outnumbered Senate Democrats launched into an attack on the bill before Republican supporters had a chance to bring it up for debate on the Senate floor……Missouri is among a growing number of states where abortion opponents are working with renewed enthusiasm following President Donald Trump’s appointment of more conservative high court justices. Kentucky, Mississippi, Ohio, and Georgia have approved bans on abortion once fetal cardiac activity can be detected, which can occur in about the sixth week of pregnancy. Similar restrictions in North Dakota and Iowa have been struck down in court……Missouri’s bill also includes an outright ban on abortions except in cases of medical emergencies. But unlike Alabama’s, it would kick in only if Roe v. Wade is overturned.If courts don’t allow Missouri’s proposed eight-week ban to take effect, it includes a ladder of less-restrictive time limits ranging from 14 to 20 weeks. Roe v. Wade legalized abortion put until viability, usually at 22 to 24 weeks… May 16, 2019: NARAL Missouri tweeted: “Early this morning, the Missouri Senate voted to ban abortions eight weeks into pregnancy, even in cases of rape, incest, or human trafficking. Criminal penalties could send doctors to prison for up to 15 years. We will not stand for this. We will fight.” May 16, 2019: The Hill posted an article titled: “House GOP leader says Alabama abortion ban goes ‘further than I believe'”. It was written by Justin Wise. From the article: House Minority Leader Kevin McCarthy (R-Calif.) said Thursday he believes an Alabama law banning nearly all abortions goes too far.“It goes further than I believe, yes,” McCarthy said during a press conference when asked about the restrictive policy.McCarthy emphasized his opposition to abortion ……But he added that he always felt there should be exceptions – such as for cases of rape, incest and the life of a woman being at risk – when it comes to the law. May 16, 2019: The American College of Obstetricians and Gynecologists (ACOG), along with the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American Osteopathic Association, and the American Psychiatric Association, posted a news release titled: “Frontline Physicians Call on Politicians to End Political Interference in the Delivery of Evidence Based Medicine”. From the news release: Our organizations are firmly opposed to efforts in state legislatures across the United States that inappropriately interfere with the patient-physician relationship, unnecessarily regulate the evidence-based practice of medicine, and, in some cases, even criminalize physicians who deliver safe, legal, and necessary medical care.Our organizations represent more than 560,000 physicians and medical students serving on the front-lines of health care. We care for patients in communities across America over the course of their lives, including when they need to make critical decisions about their futures and families. The insertion of politics between patients and their physicians undermines the foundation of trust this relationship is built on and inhibits the delivery of safe, timely, and comprehensive care. Outside interference endangers our patients’ health by limiting, and sometimes altogether eliminating, access to medically accurate information and to the full range of health care.Physicians should never face imprisonment or other penalties for providing necessary care. These laws force physicians to decide between their patients and facing criminal proceedings. Physicians must be able to practice medicine that is informed by their years of medical education, training, experience, and the available evidence, freely and without threat of criminal punishment.Our health care system faces many challenges. We call on policymakers to partner with us to advance policies that protect the sanctity of the patient-physician relationship, expand access to timely, evidence-based health care, and eliminate health disparates in our nation. May 17, 2019: The Hill posted an article titled: “Dem Louisiana governor prepared to sign fetal ‘heartbreat’ ban”. It was written by Morgan Gstalter. From the article: Louisiana Gov. John Bel Edwards (D) is reportedly prepared to break with the Democratic Party to sign a bill banning abortion after a fetal heartbeat detected if it passes in the state House, The Associated Press reported.The proposal awaits a final vote before it heads to Edwards’s desk. The legislation would ban abortions once a fetal heartbeat is detected, which is around the six-week mark, before many women even know they are pregnant.The procedure would be allowed if the pregnant woman’s health is in “serious risk,” but not for pregnancies caused by rape or incest, AP noted.The Democrat’s anti-abortion stance stems from his wife’s pregnancy nearly 30 years ago. A doctor discovered their daughter, Samantha, had spina bifida and encouraged an abortion, but the couple refused……If Edwards signs the bill into law, it would not go into effect until a similar law in Mississippi is upheld in a federal appeals court.The laws have all faced legal challenges and anti-abortion activists have said they are hoping the legislations will force the Supreme Court to overturn Roe v. Wade decision legalizing abortion nationwide.Edwards has also cited his Catholic upbringing for his stance on abortion but said the religion’s philosophy was part of his decision to expand the state’s Medicaid program, AP reported…. May 17, 2019: Senator Elizabeth Warren posted an article on Medium titled: “Congressional Action to Protect Choice”. From the Medium post: …Congress should pass new federal laws that protect access to reproductive care from right-wing ideologues in the states. Federal laws ensure real access to birth control and abortion care for all women. Federal laws that will stand no matter what the Supreme Court does.Here’s what that looks like:Create federal, statutory rights that parallel the constitutional right in Roe v. Wade. The extremists behind proposals like the Alabama law don’t reflect public opinion in America. Polling data shows that 71% of Americans oppose overturning Roe – including 52% of Republicans. Congress should do its job and protect their constituents from these efforts by establishing affirmative, statutory rights that parallel Roe vs. Wade. These rights would have at least two key components. First, they must prohibit states from interfering in the ability of a health care provider to provide medical care, including abortion services. Second, they must prohibit stats from interfering in the ability of a patient to access medical care, including abortion services, from a provider that offers them.Under the Supremacy Clause of our Constitution, federal law preempts state law. For this reason, the establishment of these federal statutory rights would invalidate contradictory state laws, such as the Alabama, Georgia, and Ohio bans. They would also end the political games being played by right-wing courts to try and narrow Roe’s protections. And because these federal protections would be valid on a variety of constitutional grounds – including equal protection and the commerce clause – they would ensure that choice would remain the law of the land, even if the Supreme Court overturns Roe.Pass federal laws to preempt state efforts that functionally limit access to reproductive health care. States have passed countless Targeted Regulations on Abortion Providers (TRAP) laws, which are designed to functionally limit and eliminate women’s access to abortion care while not technically contravening Roe. Geographical, physical, and procedural restrictions and requirements. Restrictions on medication abortion. These kinds of restrictions are medically-unnecessary and exist for only one purpose: to functionally eliminate the ability of women to access abortion services. A bill already proposed in Congress, The Women’s Health Protection Act, would provide the mechanism to block these kinds of schemes concocted to deny women access to care. Congress should pass it.Guarantee reproductive health coverage as part of all health coverage. All women – no matter where they live, where they’re from, how much money they make, or the color of their skin – are entitled to access the high-quality, evidence-based reproductive health care that is envisioned by Roe. Making that a reality starts with repealing the Hyde Amendment, which blocks abortion coverage for women under federally funded health care programs like Medicaid, the VA, and the Indian Health Service. Congress should also expand culturally – and linguistically-appropriate services and information and include immigrant women in conversations about coverage and access. Congress must also pass the EACH Woman Act, which would ensure that all future health coverage – including Medicare for All – includes contraception and abortion coverage.Ensure equal access and reproductive justice. Securing a federal right to Roe and ensuring that reproductive health care is available to every woman in America is just the beginning. We must undo the current Administration’s efforts to undermine women’s access to reproductive health care – including ending Trump’s gag rule and fully support Title X family planning funding. We must crack down on violence at abortion clinics and ensure that women are not discriminated against at work or anywhere else for the choices they made about their bodies… May 17, 2019: Cherokee Phoenix posted an article titled: “Stitt not supportive of Medicaid expansion in Oklahoma”. It was written by D. Sean Rowley. From the article: Oklahoma Gov. Kevin Stitt is not too keen on expanding Medicaid under the provisions of the Affordable Care Act, also known as “Obamacare”. Or at least he would rather the voters not force it on lawmakers.The Oklahoman recently reported that Stitt would “actively discourage” state voters from approving a Medicaid expansion by getting a state question on the November 2020 ballot……Expansion supporters have filed to gather signatures for an initiative petition to let voters decided on the funding. The petition will need 178,000 signatures to trigger a state question.The petition was sought because it’s unlikely state legislators will vote for the expansion. With Republicans controlling the House and Senate, Democrats do not hold enough seats in either chamber to derail the 75 percent approval needed for new revenue measures.Oklahoma is among 14 states that do not accept the ACA Medicaid expansion. The arguments against the expansion include the state not being able to afford it, or the possibility of the federal government offloading some funding burden to the states. Match rates vary, but the federal government currently picks up more than 90 percent of the bill for most states.Supporters have argued that Oklahoma taxpayers are helping foot the federal expense of Medicaid expansion and reaping none of the benefit……The option to take or leave Medicaid expansion was established when the U.S Supreme Court – while ruling the ACA constitutional – decided the Medicaid provisions were unreasonable. The ruling said the federal government could not withhold matching funds for state Medicaid programs if they didn’t increase eligibility to 133 percent of the federal overt level.Medicaid expansion was expected to offset some reductions to Medicare reimbursements. In states that refuse expansion, hospitals and health care providers may trie to recover lost revenue from other insured patients.Some states have attached work requirements to Medicaid eligibility. While decried by some, such requirements are believed to have little effect on benefits or costs… May 17, 2019: Planned Parenthood posted a press release titled: “Congress Approves Landmark Legislation to Halt LGBTQ Discrimination” From the press release: The U.S. House of Representatives today voted 236-173 to approve the Equality Act. As an inclusive, compassionate and non-judgmental sexual and reproductive health care provider, Planned Parenthood applauds Congress’ historic legislation to protect and strengthen the civil rights of LGBTQ people across the country. There are currently no federal protections for LGBTA people in the United States, leaving individuals vulnerable to discrimination in health care, employment, housing, credit, public spaces and services, education, federally assisted programs, and jury service. In 30 states, LGBTQ people can be fired, refused housing, or denied services simply because of who they are.The bill was introduced with bipartisan support by Representatives David Ciciline (D-RI) and Brian Fitzpatrick (R-PA) in the House and passed today with bipartisan support.Planned Parenthood is proud to provide health care to LGBTQ people across the country – including breast and cervical cancer screenings, STI testing and treatment, and birth control. Health Centers in 28 states provide hormone therapy, and some also provide puberty blockers. Many health centers also offer pre-exposure prophylaxis PREP – a daily pill that can help reduce transmission for people who are at high risk for HIV – and post-exposure prophylaxis (PEP) – a series of pills that, if taken within 72 hours of being exposed to HIV, can lower your chances of getting it… May 17, 2019: Representative David Cicilline posted a thread of tweets that started with this tweet: “BREAKING: House of Representatives just passed the Equality Act!” Representative David Cicilline continued his thread with this tweet: “The LGBTQ community has waited nearly 250 years for full equality in our country. Today, we’re one step closer to that goal.”Representative David Cicilline continued his thread with this tweet: “Equal treatment under the law and a commitment to fairness and equality are founding values of our country. Discrimination of any kind is wrong and no one should ever be treated as less than equal because of who they are or who they love.”Representative David Cicilline continued his thread with this tweet: “The American people overwhelmingly support this bill in every single state.”Representative David Cicilline concluded his thread with this tweet: “In fact, 84% of Kentucky residents support protections for the LGBTQ community. I hope that Senator McConnell will bring this bill to floor as soon as possible. If he chooses not to do so, his constituents will have a chance to hold him accountable in just 18 months.”The full text of H.R. 5 – Equality Act is available online. May 17, 2019: Lambda Legal posted a press release titled: “HISTORIC: House of Representatives Votes To Pass The Equality Act.” From the press release: Today the U.S. House of Representatives passed by a 236-173 vote H.R.5, the Equality Act, the federal bill introduced by U.S. Reps. David Cicilline (D-RI) and Brian Fitzpatrick (R-PA), as well as Senators Jeff Merkley (D-OR), Susan Collings (R-ME), Tammy Baldwin (D-WI), and Cory Booker (D-NJ), that updates existing federal non discrimination laws, including the Civil Rights Act of 1964 and the Fair Housing Act, to confirm that discrimination based on sex.The bill, which now moves to the U.S. Senate, affirms the many court decisions which have concluded that discrimination against LGBT people in employment, education, and credit violates the federal sex discrimination bans.Further, it adds protections against sex, sexual orientation and gender identity discrimination to the federal laws covering public accommodations and federally funded programs… May 17, 2019: NARAL Pro-Choice America posted a press release titled: “Missouri bill would ban abortion at nearly every stage of pregnancy in another extreme attempt to criminalize abortion and overturn Roe v. Wade”. From the press release: In response to the Missouri state legislature passing an extreme ban on abortion today, with no exceptions for rape or incest, and which would threaten doctors with prison time, NARAL Pro-Choice America President Ilyse Hogue issued the following statement:“Women across America are still reeling in the wake of Alabama’s abortion ban, and today, Missouri just delivered another blow. Anti-choice politicians, with Donald Trump in charge, are pushing a cruel agenda that puts politicians in between women and their doctors, hurts families, embodies the epitome of government overreach, and aims to send this country backwards to the dark ages. Their cruelty is on full display this week but we are watching and fighting back.“The fight for reproductive freedom is at a tipping point. These extreme bans, which are intended explicitly to undo Roe v. Wade, paint a clear picture for the American people of the future anti-choice politicians want for them. It’s the opposite of the future we’re working to build and it’s certainly not the future 7 in 10 Americans who support access to safe and legal abortion want to see.”……Additional background:Last Tuesday, Alabama’s Senate passed a total abortion ban, which will send doctors to prison for up to 99 years and is explicitly designed to overturn Roe v. Wade. And before the bill’s ink was even dry, Republican Governor Kay Ivey signed it into law, saying it is the “best opportunity” for Roe v. Wade to be revisited.Days ago, Georgia’s governor Brian Kemp signed into law a bill that makes abortion illegal before many women even know they’re pregnant, could throw doctors in jail, and could lead to women being investigated for a miscarriage.This year alone, the governors of Georgia, Kentucky, Mississippi, and Ohio signed into law bills that ban abortion before many women know they are pregnant.Ohio is now considering legislation that would put politicians between a woman and her doctor in potentially life-threatening situations – and that was after already passing one of the most restrictive bans in the country.This legislative session, the Texas legislature considered a bill that would threaten women seeking an abortion with the death penalty. Republican leaders in the legislature actually gave this bill a hearing, legitimizing the draconian and dystopian proposal.Just this year alone, nearly 30 bans on abortion have been introduced, passed, or signed into law in statehouses around the country. May 17, 2019: Center for Reproductive Rights posted a statement titled: “Statement from Nancy Northup, President & CEO of the Center for Reproductive Rights, on HB 126 passed by the Missouri Legislature today:” From the statement: “Without shame and on the heels of Alabama’s new criminal abortion ban, the Missouri legislature has passed an unconstitutional, complete ban on abortion.“This bill mocks reproductive health care by creating tax credits for donations to fake clinics and makes it a crime for doctors who provide abortion care. We are alarmed by callous and extreme politicians who seek to deny women the ability to make decisions about their reproductive health and lives.“Almost 50 years of core protections for women’s reproductive decision-making have been upheld by the U.S. Supreme Court. Missouri and Alabama’s recent criminal abortion bans, and all other affronts to Roe v. Wade, will be challenged and blocked according to precedent and settled law.” May 17, 2019: The Texas Tribune posted an article titled: “Texas House advances bill banning cities from partnering with Planned Parenthood on any services”. It was written by Arya Sundaram. From the article: Texas and its local governments would no longer be able to partner with abortion providers or their affiliates – even for services like sexual health education and pregnancy prevention initiatives – under a bill the Texas House passed in a preliminary vote late Friday after hours of emotional debate.Senate Bill 22, which critics call the biggest threat to Planned Parenthood this legislative session, would forbid a government entity from transferring money to an abortion provider, even for services not related to the procedure. It would also bar a transfer of goods or services and any transactions that offer the provider “something of value derived from state or local tax revenue.” Abortion rights advocates fear that the bill could even prohibit privately funded programs held on government property, like pop-up sexual health education booths at community colleges.The controversial bill dominated the lower chamber’s agenda Friday for more than seven hours and tentatively passed in an 81 to 65 vote……The bill needs one more vote in the lower chamber before it heads back to the Republican-controlled Senate. State Rep. Jonathan Stickland, R-Bedford, added an amendment that clarifies the bill would not restrict a city or county from banning abortions. If the upper chamber agrees with that change, the bill will then head to Republican Gov. Greg Abbott’s desk.The bill would also apply to an affiliate of an abortion provider, so no Planned Parenthood clinic could partner with a local government – even clinics that don’t provide abortions that would include programs like one in Dallas County where Planned Parenthood staffers have provided sexual health education, including information on how to prevent sexually transmitted diseases, at juvenile detention centers. Abortion-rights advocates and several Democrats lambasted the bill… May 18, 2019: The State posted an article titled: “SC governor pledges to sign strict ‘fetal heartbeat’ abortion ban”. From the article: As sweeping abortion bans advance across the South and Midwest, Republican Gov. Henry McMaster pledged to his party’s faithful Saturday that South Carolina will follow suit……South Carolina’s anti-abortion movement scored a victory last month with passage in the S.C. House of a bill that would effectively ban most abortions in the state, following years of efforts – some successful – to restrict women’s access to abortions in South Carolina. The bill is now in the S.C. Senate, where it could be debated next year.The S.C. bill would make it illegal for an abortion to be performed once a fetal heartbeat is detected – usually within five to six weeks, before many women know they are pregnant and before the fetus can survive outside the womb. The bill requires a doctor to test for a heartbeat by ultrasound before performing an abortion and allow the mother to see the ultrasound and hear the heartbeat.If the bill becomes law, a doctor who performs an abortion on a fetus with a heartbeat would face a felony charge, punishable by a $10,000 fine or up to two years in prison, or both……Opponents, including Planned Parenthood, say the bill restrict a woman’s ability to make decisions about her body with her doctor. They also say many women who are poor and have limited means to travel would have few options other than to terminate their own pregnancies… May 19, 2019: Senator Kristin Gillibrand tweeted: “To every person experiencing a pregnancy you can’t or don’t want to carry: Only you know the best decision for you. You owe nobody an explanation – especially not politicians. Abortion is still a constitutional right, and we’ll make sure it stays that way. #AbortionIsHealthCare”. May 19, 2019: The Guardian posted an article titled: “Trump backs abortion in cases of rape or incest, contradicting Alabama law”. It was written by Padraig Collins. From the article: Donald Trump, in a series of late night posts on Twitter, has outlined a less restrictive view of abortion than that just passed by Alabama’s Republican state government.Alabama now bans abortion except if there is a “serious health risk” to the mother, with no exceptions for rape and incest, but the president says he favors making an exception of cases of rape and incest. “As most people know, and for those who would like to know, I am strongly pro-life, with the three exceptions – rape, incest, and protecting the life of the mother – the same position taken by Ronald Reagan,” Trump tweeted.The president said judicial appointments have helped in moving the US to further restrictions on abortion. “We have come very far in the last two years with 105 wonderful new judges (with many more to come), two great new Supreme Court justices… and a whole new and positive attitude about the right to life.” Trump said abortion will be a major issue in his re-election campaign… May 19, 2019: Forbes posted an article titled: “Obamacare Regains Strength Despite Trump’s Legal Assault”. It was written by Bruce Japsen. From the article: Even with a potentially devastating court case hanging over the Affordable Care Act, health insurers say they are expanding coverage option to new markets thanks to an improving financial performance.Oscar Health, which made its name as a startup focused on providing Obamacare coverage, last week was the latest health insurer to announce improving profits and future expansion of health benefits under the ACA in 2020 and beyond….…Oscar’s expansion strategy and similar moves by other insurers comes despite the Donald Trump White House’s efforts through the U.S. Justice Department to invalidate the entire ACA. Earlier this month, the Justice Department filed a formal request to strike down the law, which expanded health insurance coverage to more than 20 million Americans.But health insurer business strategies are becoming more aggressive as the market stabilizes in part because of price increases and Democratic control of the U.S. House Representatives, which has vowed to fight Trump’s and Republican efforts to strip away the ACA’s patient protections, particularly those with pre-existing and medical conditions…. May 20, 2019: The Hill posted an article titled: “Pro-ObamaCare group launches ad campaign to protect 20 House Dems”. It was written by Peter Sullivan. From the article: A pro-ObamaCare group on Monday announced that it is launching a seven-figure advertising campaign aimed at protecting 20 House Democrats who could face tough reelections.The ad campaign by Protect Our Care will highlight the Democrats’ work on health care and argue that Democratic lawmakers are protecting people with pre-existing conditions, an issue that helped the party win back the House in the 2018 midterm elections……The 20 Democrats include a range of lawmakers such as Reps. Lauren Underwood (Ill.), Elissa Slotkin (Mich.) and Andy Kim (N.J.) who unseated Republicans last year, running in large part on health care.Protect Our Care last week launched digital ads thanking the 20 lawmakers for voting in favor of a bill aimed at shoring up ObamaCare and lowering drug prices……Protect Our Care said that in addition to the new advertising campaign, it will also have staff on the ground in those House districts. May 20, 2019: WAFB9 posted an article titled: “Louisiana House seeking to cover more children in Medicaid”. From the article: House lawmakers are proposing to expand Louisiana’s Medicaid program to include more children with disabilities whose parents make too much money to qualify under current eligibility rules.Legislation by Republican Rep. Dodie Horton would require Louisiana’s health department to seek federal approval for the expansion.The expansion would give the children access to home- and community-based services.Horton says the bill would help working families. The health department estimates 1,600 more children would be eligible for Medicaid.The House voted 98-0 for the proposal Monday, sending it to the Senate…. May 21, 2019: Reno Gazette Journal posted an article titled: “Nevada advances abortion decriminalization bill amid protests over Alabama’s abortion ban”. It was written by James DeHavern. From the article: The Nevada Assembly has passed a wide-ranging bill to decriminalize abortion procedures, moving the measure one step closer to the governor’s desk on a day of nationwide protests against a wave of abortion restrictions enacted in other states.No Republicans joined the near-unanimous bloc of Assembly Democrats who supported Senate Bill 179, also known as the Trust Nevada Women Act. The measure passed to polite nods of approval from pro-choice advocates gathered for a Tuesday rally in Carson City. It now heads back to the state Senate, where lawmakers will have to concur on a minor amendment before sending the bill to Gov. Steve Sisolak.SB 179 would repeal existing prohibitions on self-induced abortions and drugs that cause a miscarriage.The bill also strikes a requirement that makes doctors explain “the physical and emotional implications” of an abortion. If passed, doctors would be allowed to simply “describe the nature and consequences of the procedure” in a patient-signed consent form. They would no longer have to record the age of the patient seeking the procedure.Pro-choice advocates, like many lawmakers, see the bill as an important bulwark against a rising tide of threats to longstanding federal abortion protections……Nevada’s abortion statute, first enacted in 1973 and upheld by voters in a 1990 referendum, allows a woman to have a physician-provided abortion within the first 24 weeks of pregnancy.Abortions provided outside that time frame are only legal if the mother’s life or health is in danger. Violations of the law are punishable by up to 10 years in prison and as much as $10,000 in fines. No one has ever been prosecuted under the statute.SB 179 would do away with all that, prompting fierce resistance from pro-life advocates… May 21, 2019: Andrew Yang tweeted: “Certainly the recently passed abortion laws in Alabama and other states are dramatic moves in the wrong direction. We should #stopthebans and protect women’s reproductive rights.” May 21, 2019: Clarion Ledger posted an article titled: “Federal judge’s questions point toward striking down Mississippi’s latest abortion ban”. It was written by Sarah Fowler. From the article: U.S. District Judge Carlton W. Reeves on Tuesday had several pointed questions about Mississippi’s fetal heartbeat abortion ban, noting that he had struck down a less-restrictive ban last year.Reeves had arguments in Jackson from the Center for Reproductive Rights, the group challenging Mississippi’s ban on abortions when a fetal heartbeat is detected, which can happen as early as six weeks into a pregnancy. Attorney General Jim Hood’s office is defending the law that is scheduled to go into effect July 1.When a decision will come from Reeves isn’t known. He only said Tuesday that he would decide soon.Reeves is the same judge who in November struck down as unconstitutional Mississippi’s previous 15-week abortion ban passed last year. He referenced this from the bench Tuesday to state attorney Wilson Minor.“Doesn’t it boil down to six weeks is less than 15?” Reeves asked, adding the the new law “smacks of defiance to this court.”Reeves noted that while there were exceptions for situations where the life or health of the mother is threatened by taking the pregnancy to term, the law does not include exceptions for pregnancies resulting from rape or incest.“So when a child who is raped at 10 or 11 years old, that does not open their mouth, does not tell their parents, the rapist may be in their home, nobody discovers until it’s too late – that is a fetal heartbeat has been detected – that child must bring the fetus to term under this statue, if the fetal heartbeat can be detected.” Reeves said… May 21, 2019: Governor of Wisconsin Tony Evers tweeted: “We shouldn’t be limiting the right for women to make their own healthcare decisions. That’s why I’ll veto the bills passed by the Assembly last week if they arrive on my desk. It’s time to listen to women. #StopTheBans” May 21, 2019: The Hill posted an article titled: “Wisconsin governor vows to veto abortion restriction bills passed by state lawmakers”. It was written by Justin Wise. From the article: Wisconsin Gov. Tony Evers (D) on Tuesday vowed to veto abortion restrictions the state assembly passed last week, saying that government should allow women to make their own health care decisions….…The comments from Evers come as GOP-led legislatures around the nation move to place further restrictions on access to abortion. The Wisconsin state Assembly last week passed multiple measures that would follow suit.One of the bills the body passed was the so-called “born alive” measure, which requires abortion providers to give care to babies who survive abortion attempts, according to Wisconsin Public Radio. Doctors would reportedly face prison time if they did not provide necessary medical care……The state Assembly also passed three additional measures related to abortion, including one that bans a woman from having the procedure done based on the fetus’ race, sex or defects.The Assembly also voted to eliminate the remaining bit of public funding that is available for Planned Parenthood, The Milwaukee Journal Sentinel reported… May 21, 2019: Portland Press Herald posted an article titled: “Bill to allow more medical professionals to perform abortions is closer to passage”. It was written by Scott Thistle. From the article: The Maine Legislature took another step toward expanding access to abortion Tuesday, with the House of Representatives approving a bill that authorizes nurse practitioners and physician assistants to perform abortions.The 74-58 vote, largely along party lines with Republicans in opposition and Democrats in support, will now go to the state Senate, where Democrats also hold the majority, for a vote that will likely be taken later this week.Supports of the bill, which is also backed by Gov. Janet Mills, a Democrat, said the measure will provide women, especially those in rural Maine, with more access to abortion services without having to travel to one of 20 clinics in Maine that offer abortions. Licensed physicians offer surgical and medication abortions at clinics in Portland, Augusta, and Bangor, and medication abortions up to 10 weeks of gestation are available at 18 clinics where doctors connect with patients via videoconference……Last week both houses of the Maine Legislature passed a bill that requires the state to fund abortion under its Medicaid program and that obligates private insurers to include abortion among pregnancy-related benefits.Denise Tepler, D-Topsham, one of the bill’s co-sponsors, said in a floor speech that many women support the bill because it allows them to seek abortion services from the primary health car providers with whom they already have a longstanding relationship……She pointed out that leading medical groups, including the Maine Medical Association and the American College of Gynecologists and Obstetricians, support granting abortion service authorization to advanced practice clinicians……The bill will now head to the Maine Senate, where it faces additional votes. May 21, 2019: Representative Ayanna Pressley tweeted: “Today I filed a resolution affirming Congress’s support of Roe v. Wade. Our right to bodily autonomy. Our right to reproductive justice. #StopTheBans” The “Maximizing Outcomes for Moms Through Medicaid Improvement and Enhancement of Services Act” (or the MOMMIES Act), was introduced by Senator Corey Booker (D-NJ) and Representative Ayanna Pressley. The MOMMIES Act includes six Medicaid-related strategies to maximize maternal and infant health outcomes. Specifically, it would: Enhance CHIP and Medicaid coverage for pregnant women by extending it from 60 days to 365 days following childbirth.Establish and evaluate a Maternity Care Home Demonstration Project. Maternity care home models use a team-based approach to provide a wide array of essential services from dental care and mental health counseling, to care navigation, lactation support, health education, and community-based doula support. This model of care integrates basic and speciality health care with care coordination and support services in a culturally-appropriate way to improve quality of care, improve birth outcomes, and provide continuity of care.Increase Medicaid coverage of doula care by directing the Medicaid and CHIP Payment and Access Commission (MACPAC) to report on the coverage of doula care under state Medicaid programs and create strategies to improve access. The Centers for Medicare & Medicaid Service (CMS) will issue recommendations and guidance to state Medicaid offices on steps they can take to increase coverage for doula care.Expand Medicaid coverage to a full range of services rather than having coverage that can be limited to pregnancy-related services.Increase Medicaid minimum reimbursement rates for maternal and obstetric services using established Medicare rates as benchmarks.Increase access to maternity care through telemedicine by generating a report to congress on the current use of telemedicine by state Medicaid programs and expanding on existing efforts by providing adequate recommendations. The MOMMIES Act is endorsed by: Ancient Song Doula ServicesAssociation of Maternal & Child Health ProgramsBlack Mamas Matter AllianceBlack Women’s Health ImperativeCenter for Reproductive RightsChildren’s Dental Health ProjectEvery Mother CountsIn Our Own VoiceMarch of DimesMomsRisingNational Asian Pacific American Women’s ForumNational Health Law ProgramNational Latina Institute for Reproductive HealthNational Partnership for Women & FamiliesNational Women’s Law Center1000 Days May 21, 2019: Leana Wen, M.D., President and CEO of Planned Parenthood tweeted: “**Reminder to those who need it** Abortion care is still legal in all 50 states. You can keep your appointments, you can still come in, you can still get care. We’ll make sure of it today, tomorrow & we’ll fight these laws so that it stays that way – no matter what. #StopTheBans” May 22, 2019: The Hill posted an article titled: “Booker vows to form White House office on abortion rights”. It was written by Jessie Hellmann. From the article: Sen. Cory Booker (D-N.J.), a 2020 presidential candidate, vowed Wednesday to create a White House office solely focused on expanding access to abortion and addressing barriers to reproductive health.The White House Office of Reproductive Freedom would be charged with “coordinating and affirmatively advancing abortion rights and access to reproductive care” across the Booker administration.Booker would also repeal a long-standing ban on federal funding for abortions and rollback several of President Trump’s abortion restrictions……Booker said he would end the administration’s changes to the Title X family planning program that prohibits clinics from referring women for abortions, and roll back new rules that aim to protect health care workers and institutions from having to violate their religious or moral beliefs by participating in abortions, providing contraception, sterilization or other procedures…He also indicated that he would end a Trump policy that exempts employers from ObamaCare’s contraception mandate if they have moral or religious objections to providing birth control to their workers… May 23, 2019: Reuters posted an article titled: “5th Circuit sets arguments over constitutionality of Obamacare for July 9”. It was written by Nate Raymond. From the article: A federal appeals court on Thursday said it would hear arguments July 9 in a lawsuit by 18 Republican-led states challenging the constitutionality of the Affordable Care Act, a case that is now backed by President Donald Trump’s administration.The 5th Circuit Court of Appeals in New Orleans set the date after agreeing in April to the request of the 21 Democratic attorneys general defending the law to expedite their appeal of a ruling by a district court judge in Texas declaring the law unconstitutional… May 23, 2019: News8 WTNH.com posted an article titled: “Lamont/Dems want state version of Obamacare, Repubs outraged at last minute proposal”. It was written by Mark Davis. From the article: It’s a Connecticut version of Obamacare, right down to imposing tax penalties if you decide not to buy insurance.Governor Lamont and Democratic leaders said it will help many Connecticut residents and businesses……The ‘Connecticut Option’ health insurance plan has as a goal to reduce premiums by 20 percent and reduce prescription drug costs by importing from Canada, as is being done in several other states. It would also make more people eligible for Medicaid.To pay for it, the plan would impose a surcharge on the insurance companies and place a tax on opioid manufacturers. Like the repealed individual mandate for Obamacare, the state would impose a penalty tax on people that do not buy insurance. The plan would be administered through State Comptroller Kevin Lembo, who said, “This thing we are doing today is the most significant thing we can do to help small businesses to grow and prosper in Connecticut.”The Republican leader in the Senate, Sen. Len Fasano (R-North Haven” said this major change in state policy has been sprung on Republicans at the last minute with no opportunity for input… May 23, 2019: The Hill posted an article titled: “Bipartisan senators reveal sweeping health care package”. It was written by Nathaniel Weixel. From the article: A sweeping draft legislative package from the bipartisan leaders of the Senate Health Committee seeks to lower health care costs by addressing surprise medical bills and adding transparency to drug prices, among other provisions.The bipartisan draft from committee Chairman Lamar Alexander (R-Tenn.) and Sen. Patty Murray (Wash.), the panel’s top Democrat comes as the pair have been working to find areas of agreement where both parties can take action on health care……The package contains nearly three dozen specific bipartisan provisions that will reduce the cost of what Americans pay for health care, Alexander said. It sidesteps controversial issues like ObamaCare repeal, Medicare for All and abortion funding.Aside from the surprise billing, the package also aims to provide transparency to rebates between drug companies and the pharmacy benefits manager “middlemen”.The goal is to bring the package to the Senate floor this summer, and Alexander and Murray requested members submit comments on the bill by June 5… May 23, 2019: Representative Judy Chu (Democrat-California) posted a press release on her official website titled: “Chu, Blumenthal, Fudge, Frankel, & Baldwin Introduce Bicameral Federal Legislation to Guarantee Equal Access to Abortion, Everywhere”. From the press release: Following the recent passage of restrictive anti-choice laws in Alabama, Georgia and Missouri, U.S. Representative Judy Chu (CA-27) and U.S. Senator Richard Blumenthal (D-CT), along with Representatives Marcia Fudge (OH-11) and Lois Frankel (FL-21) and Senator Tammy Baldwin (D-WI) joined leading women’s health advocates to announce introduction of the Women’s Health Protection Act (WHPA), bicameral federal legislation to guarantee equal access to abortion, everywhere. Introduced with historic support by Chu and Blumenthal, WHPA has 42 co-sponsors in the Senate and 171 co-sponsors in the House of Representatives.WHPA guarantees a pregnant person’s right to access an abortion – and the right of an abortion provider to deliver these abortion services – free from medically unnecessary restrictions that interfere with a patient’s individual choice or the provider-patient relationship.From Roe v. Wade in 1973 to Whole Woman’s Health v. Hellerstedt in 2016, the Supreme Court has repeatedly recognized abortion as a constitutional right. However, anti-abortion advocates have worked for years at the state-level to pass laws meant to undermine or eliminate access to abortion care. Just in this legislative session, 34 laws that restrict and impede access to abortion have already passed in 15 states this legislative session and another 350 restrictive laws have been introduced. WHPA would stop these attacks and ensure that abortion access first guaranteed under Roe is a reality for everyone, everywhere.A recent Politico-Morning Consult national tracking survey found that a majority of registered voters oppose the restrictive laws passed Georgia and Alabama, including 59 percent of women and 55 percent of independents. The same survey also found that 53 percent oppose overturning Roe v. Wade – including 48 percent of Republican voters……The bill is co-sponsored in the Senate by U.S. Senators Chuck Schumer (D-NY), Dick Durbin (D-IL), Patty Murray (D-WA), Dianne Feinstein (D-CA), Bob Menendez (D-NJ), Sherrod Brown (D-OH), Kamala Harris (D-CA), Jeff Merkley (D-OR), Sheldon Whitehouse (D-RI), Michael Bennet (D-CO), Edward J. Markey (D-MA), Elizabeth Warren (D-MA), Ben Cardin (D-MD), Martin Heinrich (D-NM), Debbie Stabenow (D-MI), Amy Klobuchar (D-MN), Jon Tester (D-MT), Jacky Rosen (D-NV), Chris Coons (D-DE), Catherine Cortez Masto (D-NV), Jeanne Shaheen (D-NH), Bernie Sanders (I-VT), Mazie Hirono (D-HI), Maggie Hassan (D-NH), Brian Schatz (D-HI), Angus King (I-ME), Tina Smith (D-MN), Gary Peters (D-MI), Ron Wyden (D-OR), Kirsten Gillibrand (D-NY), Chris Murphy (D-CT), Patrick Leahy (D-VT), Tammy Duckworth (D-IL), Chris Van Hollen (D-MD), Tom Carper (D-DE), Maria Cantwell (D-WA), Cory Booker (D-NJ), Mark Warner (D-VA), Tom Udall (D-NM), Tim Kaine (D-VA), and Kyrsten Sinema (D-AZ).The bill is co-sponsored in the House by U.S. Representatives Alma Adams (NC-12), Pete Aguilar (CA-31), Colin Allred (TX-32), Nanette Barragan (CA-44), Karen Bass (CA-37), Joyce Beatty (OH-03), Ami Bera (CA-07), Don Beyer (VA-08), Earl Blumenauer (OR-03), Lisa Blunt Rochester (DE-At Large), Suzanne Bonamici (OR-01), Brendan Boyle (PA-02), Anthony Brown (MD-04), Julia Brownley (CA-26), Cheri Bustos (IL-17), G.K. Butterfield (NC-01), Salud Carbajal (CA-24), Tony Cardenas (CA-29), Andre Carson (IN-07), Ed Case (HI-01), Sean Casten (IL-06), Kathy Castor (FL-14), David Cicilline (RI-01), Gil Cisneros (CA-39), Katherine Clark (MA-05), William Lacy Clay (MO-01), Steve Cohen (TN-09), Gerry Connolly (VA-11), Jim Cooper (TN-05), TJ Cox (CA-21), Charlie Crist (FL-13), Jason Crow (CO-06), Elijah Cummings (MD-07), Susan Davis (CA-53), Danny K. Davis (IL-07), Madeleine Dean (PA-04), Peter DeFazio (OR-04), Dianna DeGette (CO-01), Rosa DeLauro (RI-03), Suzan DelBene (WA-01), Antonio Delgado (NY-19), Val Demmings (FL-10), Mark DeSaulnier (CA-11), Ted Deutch (FL-22), Debbie Dingell (MI-12), Lloyd Doggett (TX-35), Eliot Engel (NY-16), Veronica Escobar (TX-16), Adriano Espaillat (NY-13), Dwight Evans (PA-03), Lizzie Fletcher (TX-07), Bill Foster (IL-11), Lois Frankel (FL-02), Marcia Fudge (OH-11), Ruben Gallego (AZ-07), John Garamendi (CA-03), Jesus Garcia (IL-04), Sylvia Garcia (TX-29), Jimmy Gomez (CA-34), Al Green (TX-09), Raul Grijalva (AZ-03), Deb Haaland (NM-01), Alcee Hastings (FL-20), Jahana Hayes (CT-05), Denny Heck (WA-10), Brian Higgins (NY-26), Katie Hill (CA-25), Jim Himes (CT-04), Eleanor Holmes Norton (DC), Steven Horsford (NV-04), Chrissy Houlahan (PA-06), Jared Huffman (CA-02), Sheila Jackson Lee (TX-18), Pramila Jayapal (WA-07), Hank Johnson (GA-04), Eddie Bernice Johnson (TX-30), Marcy Kaptur (OH-09), Robin Kelly (IL-02), Joe Kennedy (MA-04), Ro Khanna (CA-17), Derek Kilmer (WA-06), Ron Kind (WI-03), Ann Kirkpatrick (AZ-02), Raja Krishnamoorthi (IL-08), Ann M. Kuster (NH-02), Rick Larsen (WA-02), Brenda Lawrence (MI-14), Al Lawson Jr. (FL-05), Barbara Lee (CA-13), Susie Lee (NV-03), Andy Levin (MI-09), John Lewis (GA-05), Ted Lieu (CA-33), David Loebsack (IA-02), Zoe Lofgren (CA-19), Alan S. Lowenthal (CA-47), Nita Lowey (NY-17), Ben Ray Lujan (NM-03), Carolyn B. Maloney (NY-12), Sean Patrick Maloney (NY-18), Doris Matsui (CA-06), Lucy McBath (CA-06), Betty McCollum (MN-04), A. Donald McEachin (VA-04), James P. McGovern (MA-02), Gregory W. Meeks (NY-05), Grace Meng (NY-06), Joseph D. Morelle (NY-25), Gwen Moore (WI-04), Seth Moulton (MA-06), Debbie Mucarsel-Powell (FL-26), Jerrold Nadler (NY-10), Grace F. Napolitano (CA-32), Joseph Neguse (CO-02), Tom O’Halleran (AZ-01), Alexandria Ocasio-Cortez (NY-14), Ilhan Omar (MN-05), Jimmy Panetta (CA-20), Chris Pappas (NH-01), Donald M. Payne (NJ-10), Ed Perlmutter (CO-07), Scott H. Peters (CA-52), Chellie Pingree (ME-01), Mark Pocan (WI-02), Katie Porter (CA-45), Ayanna Pressley (MA-07), David Price (NC-04), Mike Quigley (IL-05), Jamie Raskin (MD-08), Kathleen Rice (NY-04), Cedric Richmond (LA-02), Harley Rouda (CA-48), C.A. Dutch Ruppersberger (MD-02), Linda T. Sanchez (CA-38), John P. Sarbanes (MD-03), Mary Gay Scanlon (PA-05), Janice D. Schakowsky (IL-09), Adam Schiff (CA-28), Bradley Scott Schneider (IL-10), Kurt Schrader (OR-05), Kim Schrier (WA-08), Bobby Scott (VA-03), David Scott (GA-13), Jose E. Serrano (NY-15), Terri A. Sewell (AL-07), Donna Shalala (FL-27), Brad Sherman (CA-30), Mikie Sherrill (NJ-11), Albio Sires (NJ-08), Adam Smith (WA-09), Darren Soto (FL-09), Jackie Speier (CA-14), Thomas R. Suozzi (NY-02), Eric Swalwell (CA-15), Mark Takano (CA-41), Mike Thompson (CA-05), Bennie Thompson (MS-02), Dina Titus (NV-01), Rashida Tlaib (MI-13), Paul Tonko (NY-20), Norma J. Torres (CA-35), Lori Trahan (MD-03), David Trone (MD-06), Filemon Vela (TX-34), Nydia M. Velasquez (NY-07), Debbie Wasserman Schultz (FL-23), Bonnie Watson Coleman (NJ-12), Peter Welch (VT-At Large), Jennifer Wexton (VA-10), Susan Wild (PA-07), Frederica Wilson (FL-17), and John Yarmuth (KY-03). WHPA is also endorsed by leading women’s health and civil rights organizations, including the Center for Reproductive Rights, Planned Parenthood Federation of America, NARAL Pro-Choice America, and the ACLU… May 23, 2019: Center for Reproductive Rights posted a press release titled: “Center for Reproductive Rights Fully Supports New Federal Legislation to Protect Abortion Access”. From the press release: Today, the Center for Reproductive Rights joined leaders in Congress and reproductive health, rights, and justice advocates to celebrate the reintroduction of the Women’s Health Protection Act of 2019 – federal legislation that would protect abortion access from state-level bans and restrictions threatening to eliminate access around the country.The Women’s Health Protection Act is being introduced in the House by U.S. Representatives Judy Chu (D-Calif.), Lois Frankel (D-Fla.), and Marcia Fudge (D-Ohio), and in the Senate by Senators Richard Blumenthal (D-Conn.) and Tammy Baldwin (D-Wis). This bill would create a national safeguard to assure abortion access throughout the United States.“With an alarming number of states enacting abortion bans and President Trump’s pledge to overturn Roe, we’re taking nothing for granted,” said Nancy Northup, President and CEO of the Center for Reproductive Rights. “The Woman’s Health Protection Act will ensure that a woman’s ability to access abortion care does not depend on her zip code, and we will work tirelessly to guarantee that in law.”The Woman’s Health Protection Act, also known as WHPA, already has 171 supporters in the House and 42 in the Senate.The Woman’s Health Protection Act would protect abortion access from the waves of increasingly punitive state-level laws, like Alabama’s near-total ban, that prevent people from making personal decisions about their health, their lives, and their futures……The Supreme Court has repeatedly ruled – most recently in 2016 – that abortion is a constitutional right that cannot be hindered by “undue burdens.” Despite these legal guarantees, more than 150 harmful, restrictive laws have been passed in the last three years alone. Evidence shows that these restrictions threaten the quality of medical care patients receive and cause harms that fall most heavily on already marginalized populations: those living in poverty, people of color, LGBTQ+ people, those living in rural areas, and young people……The Women’s Health Protection Act establishes a statutory right for health care providers to provide care, and a corresponding right for their patients to receive care, free from medically unnecessary limitations and bans that single out abortion and impede access to services. Restrictions that would be unlawful under the Women’s Health Protection Act include six-week bans, unnecessary tests and procedures, and requirements that providers obtain admitting privileges at local hospitals. May 23, 2019: Planned Parenthood posted a press release titled: “Congress Moves to Protect Access to Safe, Legal Abortion”. From the press release: Today, Congress moved to protect access to safe, legal abortion across the country with the introduction of the Women’s Health Protection Act (WHPA). Led by reproductive health champions Sen. Richard Blumenthal (D-CT) and 43 co-sponsors in the Senate, and Rep. Judy Chu (CA-27) and 174 co-sponsors in the House of Representatives, this critical piece of legislation would block medically unnecessary abortion restrictions being pushed forward by state politicians……On Tuesday, May 21, hundreds of thousands of activists marched at more than 500 events all across the nation to protest abortion bans. Activists gathered on the steps of the Supreme Court and in state capitals across the country, flooding Alabama with rallies, more than 2,000 gathering in Missouri, and more than 5,000 marching in Oregon. Nearly one in four women will have an abortion in this country… The press release included a statement from Dr. Leana Wen, President and CEO of Planned Parenthood: “This is the legislation that we need to protect women’s access to health care. We applaud this new effort by our champions in Congress to keep politicians from interfering in patient’s personal health decisions and to protect our rights to access to healthcare, including safe, legal abortion. As a doctor, I am focused on ensuring the health and well-being of women and families. The Women’s Health Protection Act will be a critical effort to help protect people across our country from this unprecedented attack on our rights and freedoms.” May 23, 2019: NARAL Pro-Choice American posted a press release titled: “Landmark federal legislation restores dignity to women’s healthcare, safeguards reproductive freedom during time of unprecedented attacks in the states”. From the press release: After the Women’s Health Protection Act (WHPA) was introduced in Congress today by Senator Richard Blumenthal and Representative Judy Chu, NARAL Pro-Choice America President Ilyse Hogue issued the following statement:“Anti-choice Republicans have launched an all-out assault on reproductive freedom, mercilessly chipping away at our rights and stripping access to abortion through everything from unnecessary regulations all the way to total bans on abortion. And it’s women and families who are paying the price,” said NARAL Pro-Choice America President Ilyse Hogue. “We, the seven in 10 Americans who support abortion access, say ‘no more.’ It’s time for legislation that takes reproductive freedom seriously – and that’s the Women’s Health Protection Act. NARAL applauds this legislation for restoring dignity to women’s healthcare and sending a clear message that our reproductive freedom is not up for debate.”The Women’s Health Protection Act comes on the heels of a wave of abortion bans sweeping the country. Bans on abortion have been introduced, passed, or signed into law in 30 states this year alone, explicitly designed to undo Roe v. Wade while outlawing abortion, criminalizing doctors, and punishing women. As abortion access hangs by a thread in states across the country, WHPA is a critical federal safeguard against the erosion of abortion access caused by medically unnecessary restrictions and bans. The bill takes a critical step toward protecting access to essential reproductive healthcare and the constitutional rights of all people, no matter where they live.The bill’s introduction also comes amidst a surge of national mobilization and outrage over abortion bans. On Tuesday, NARAL and 80 partner organizations held a National Day of Action to Stop the Bans, resulting in over 500 events across all 50 states including DC and Puerto Rico. May 23, 2019: KITV 4 ABC Island News posted an article titled: “Hawaii Attorney General continues fight to protect the Affordable Care Act”. From the article: Hawaii Attorney General Clare E. Connors, joined a coalition led by Attorney General Becerra of 20 states and the District of Columbia, in filing a response in Texas v. U.S., defending the Affordable Care Act and the healthcare of tens of millions of Americans.The brief, filed in the U.S. Court of Appeals for the Fifth Circuit on Wednesday, argues that every provision of the ACA remains valid. It further argues that the position taken by the Trump Administration and the Texas-led coalition is legally incorrect and dangerous to our healthcare system.“This is another important step in our ongoing efforts to ensure affordable health care fo Hawaii residents and millions of other Americans,” Attorney General Connors said… May 24, 2019: The Chicago Tribune posted an article titled: “Trump moves to revoke transgender health protections put in place by Obama”. It was written by Ricardo Alonso-Zaldivar. From the article: The Trump administration moved Friday to revoke newly won health care discrimination protections for transgender people, the latest in a series of actions that aim to reverse gains by LGBTQ Americans in areas ranging from the military to housing and education.The Health and Human Services Department released a proposed regulation that in effect says “gender identity” is not protected under federal laws that prohibit sex discrimination in health care. It would reverse an Obama-era policy that the Trump administration is already not enforcing……The administration also has moved to restrict military service by transgender men and women, proposed allowing certain homeless shelters to take gender identity into account in offering someone a bed for the night and concluded in a 2017 Justice Department memo that federal civil rights law does not protect transgender people from discrimination at work. As one of her first policy moves, Education Secretary Betsy DeVos withdrew guidance that allowed students to use bathrooms matching their gender identity.More than 1.5 million Americans identify as transgender, according to the Williams Institute, a think tank focusing on LGBT policy at the UCLA School of Law. A bigger number – 4.5% of the population – identify as lesbian, gay, bisexual or transgender (LGBT), according to Gallup……Pushing back against critics, the HHS official overseeing the new regulation said transgender patients would continue to be protected by other federal laws that bar discrimination on the basis of race, color, national origin, sex, age, and disability……Behind the dispute over legal rights is a medically recognized condition called “gender dysphoria” – discomfort or distress caused by a discrepancy between the gender that a person identifies as and the gender at birth. Consequences can include severe depression. Treatment can range from sex-reassignment surgery and hormones to people changing their outward appearance by adopting a different hairstyle or clothing….…Under the Obama-era federal rule, a hospital could be required to perform gender-transition procedures such as hysterectomies if the facility provided that kind of treatment for other medical conditions. The rule was meant to carry out the anti-discrimination section of the Affordable Care Act, which bars sex discrimination in health care but does not use the term “gender identity”.The proposed new rule would also affect the notices that millions of patients get in multiple languages about their rights to translation services. Such notices often come with insurer “explanation of benefits” forms. The Trump administration said the notice requirement has become a needless burden on health car providers, requiring billions of paper notices to be mailed annually at an estimated five-year cost of $3.2 billion……[The] proposal would remove “termination of pregnancy” as grounds for making a legal claim of sex discrimination in health care, one of the protections created in the Obama years… May 24, 2019: Center for Reproductive Rights posted a press release titled: “HHS Rolls Back Civil Rights Protections in Health Care”. From the press release: Today the Center for Reproductive Rights responded to a proposed rule issued by the Department of Health and Human Services (HHS) that attempts to roll back protections against sex discrimination in health care. The proposed rule, if adopted, would weaken and narrow enforcement of key civil rights protections advanced under the Affordable Care Act (ACA) Health Care Rights Law (Section 1557), which specifically prohibits discrimination on the bases of race, color, national origin, age, disability or sex in health programs or in activities that receive federal funding.Statement from Lourdes Rivera, Senior Vice President, U.S. Programs:“This proposed rule is a dangerous attack on the health of women and the LGBTQ community. It seeks to undermine civil rights laws aimed at ensuring everyone is treated equally and with respect.“No one should face discrimination when seeking medical help. Health care is a human right and a civil right. The Administration should be enforcing the protections of the Health Care Rights Law, but instead they are working to erode the law’s essential prohibitions against discrimination.“The Center for Reproductive Rights stands alongside the entire civil rights community in fighting discrimination in the health care system.”The ACA was one of the most significant advancements for women’s health in decades, prohibiting insurance companies from charging women higher premiums simply because of their gender and providing protections against coverage denials or discontinuation for individuals with preexisting conditions. In passing the ACA, Congress intended to eliminate barriers to quality, affordable health insurance coverage and health care. The Health Care Rights Law is crucial to the success of that goal.The proposed rule could put access to health care at risk for thousands of women and LGBTQ individuals… May 24, 2019: Lambda Legal posted a press release titled: “Lambda Legal: Trump Administration Assault on LGBT People Continues with New ACA Regulation”. From the press release: Today, the U.S. Department of Health and Human Services (HHS) proposed new regulations designed to roll back regulations issued during the Obama Administration that clarified that, pursuant to federal law, the sex discrimination protections of the Affordable Care Act forbid discrimination against lesbian, gay, bisexual and transgender people.The proposed regulations would carve-out LGBT people from the Affordable Care Act’s nondiscrimination protections, and purport to permit health care workers, doctors, hospitals, and health insurance companies that relieve federal funding to refuse to provide or cover health care services critical to the health and wellbeing of LGBT people, such as transition-related and reproductive care. The proposed regulations also seek to permit, yet again, health care entities and workers to be able to deny insurance or care to LGBT patients or policy-holders because of personal, religious or moral beliefs, endangering the lives of LGBT people.Lambda Legal Litigation Director Diana Flynn released the following statement:“Yet again, the Trump Administration strives to harm LGBT people; this time by rolling back crucial health care protections for LGBT people and other vulnerable persons. By repealing a regulation clarifying that LGBT people are protected against health care discrimination under the Affordable Care Act’s nondiscrimination provisions, the Trump Administration seeks to deny life-saving health care to LGBT people and others and replaces these critical protections with a narrow definition of sex, not grounded in science or the law.“The move comes during the same week that HHS finalized its Denial of Care Rule inviting heath care discrimination against LGBT people and others, and the news that the Department of Housing and Urban Development is proposing a new rule that will allow federally-funded homeless shelters to turn away transgender people. These three regulatory actions, in one week, are just the latest in the Trump administration’s unrelenting campaign to promote anti-LGBT discrimination.“The Trump-Pence administration’s targeting of the LGBT community is unmistakable and unconscionable. HHS should be in the business of ensuring that people get the health care they need, not providing excuses for providers and insurers to turn people away… May 24, 2019: Speaker of the House Nancy Pelosi posted a statement on the official Speaker of the House website. The statement was titled: “Pelosi Statement on Trump Administration Assault on Women & Transgender Americans”. From the statement: Speaker Nancy Pelosi released the following statement after the Trump Administration advanced an HHS proposed rule that would end anti-discrimination protections for women and transgender Americans in health care, days after announcing a proposed rule at HUD that would strip protections for transgender Americans at homeless shelters:“The Trump Administration’s actions show utter contempt for the health, safety and humanity of women and transgender Americans.“According to the Trump Administration’s devastating decision to throw open the doors to sex discrimination, women could be denied basic health care because of their reproductive decisions and history. By rolling back critical protections against discrimination in homeless shelters and the health care system, the Trump Administration is endangering transgender people at some of the most vulnerable and life-threatening moments of their lives. The Administration must reverse these dangerous rules before people get hurt or lose their lives.“All Americans, regardless of who they are, deserve respect and access to care and support when they are most in need.” May 24, 2019: The American Civil Liberties Union (ACLU) posted a press release titled: “ACLU Responds to Proposed Changes to Health Care Rights Law”. From the press release: The Department of Health and Human Services proposed a change to the Health Care Rights Law, Section 1557 of the Affordable Care Act, today in an attempt to roll back non-discrimination protections for transgender and nonbinary people, as well as all women and other communities historically marginalized in health care.The proposed regulation is one of several moves by this administration to redefine sex discrimination across federal law, including positions in litigation and a leaked memo that described an attempt to excise transgender people broadly from legal protections. Earlier this week, the Department of Housing and Urban Development announced a rollback of nondiscrimination protections at federally funded shelters for transgender people experiencing homelessness.Louise Melling, deputy legal director with the American Civil Liberties Union, had the following reaction:“This move by the Trump administration is nothing less than an act of violence against those whose health care needs have been historically ignored, neglected, and dismissed. Transgender and non-binary people experience staggering rates of discrimination from health care institutions and providers. They face the denial of medically necessary health care related to gender transition, harassment from medical providers, negligent care, and the refusal of medical service altogether. The administration wants to take away protections to stop that discrimination, an action that will lead to devastating health consequences. The proposed changes would also strip protections from people based on reproductive healthcare decisions including if they have had an abortion.”……”The ACLU refuses to allow the Trump administration to try and drag us backwards and roll back these essential, life-saving protections against discrimination. We will fight to make sure that who you are and the care you need will not be treated as a pre-existing condition ever again. Should HHS ever finalize this discriminatory rule, we will see them in court.” May 24, 2019: The American Civil Liberties Union posted a press release titled: “ACLU, Planned Parenthood File Lawsuit Challenging Alabama Abortion Ban”. From the press release: The American Civil Liberties Union (ACLU), ACLU of Alabama and Planned Parenthood filed a lawsuit today on behalf of Alabama abortion providers challenging an extreme law that bans abortion in nearly every case and punishes doctors with up to 99 years in prison for providing care. Governor Kay Ivey signed the bill into law on May 15, making Alabama the fifth state in this year to enact an outright abortion ban.The lawsuit comes amid nationwide opposition to the extreme ban and follows a week of protests throughout the country opposing state abortion bans. Earlier this year, Kentucky, Georgia, Ohio and Mississippi also enacted laws banning abortion, and the Missouri governor is expected to sign a ban soon. The ACLU has already obtained an injunction blocking the Kentucky ban. The ACLU, together with Planned Parenthood Federation of American, have also filed suit against the ban in Ohio and are preparing a legal challenge in Georgia. No abortion ban, including Alabama’s, is in effect and abortion remains legal in all 50 states… May 24, 2019: Essence posted an article titled: “Federal Judge Blocks Mississippi’s Anti-Abortion Fetal ‘Heartbeat” Bill”. It was written by Kirsten West Savali. From the article: U.S. District Judge Carlton Reeves blocks Mississippi’s restrictive and oppressive heartbeat abortion law on Friday, writing in his ruling, “Here we go again.”……The law was scheduled to take effect July 1.Reeves, who is only the second Black person to be appointed to the federal bench in Mississippi, is not new to making what many believe to be revolutionary decisions in a red state.In 2016, Reeves stuck down House Bill 1523, pertaining to “religious freedom,” calling out Gov. Phil Bryant for transparently attempting to write discrimination into Mississippi’s Laws, Mississippi Today reported at the time……Currently the Jackson Women’s Health Organization, also known as the Pink House, is Mississippi’s only abortion facility. Reproductive justice organizers have had to consistently battle the state for it to remain open. May 24, 2019: Center for Reproductive Rights posted a press release titled: “Six-Week Abortion Ban Blocked by Federal Court in Mississippi”. From the press release: Today, a federal district court in Mississippi temporarily blocked a state law passed in March that would ban abortion after six weeks of pregnancy. The law was set to take effect July 1, but now will remain blocked while the case proceeds. The case was filed by the Center for Reproductive Rights on behalf of Jackson Women’s Health Organization, the last remaining clinic in Mississippi.In his decision, District Judge Carlton W. Reeves wrote, “Here we go again. Mississippi has passed another law banning abortion 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.” The court’s decision mirrors its ruling in November 2018, in which the same court permanently blocked the state’s 15-week abortion ban……In November 2018, Judge Reeves struck down the state’s 15-week ban, determining that it “unequivocally” violated the Fourteenth Amendment guarantee of reproductive autonomy. In that decision, the court described the 15-week ban as “closer to the old Mississippi – the Mississippi bent on controlling women and minorities” and described as the state’s “professed interest in women’s health” as “gaslighting.”……The Center is also challenging other barriers Mississippi women must overcome to obtain an abortion:Patients must receive counseling designed to deter them from having an abortion and must then wait 24 hours before returning to the clinic to obtain an abortion.Minors must obtain consent from both of their parents or a judicial bypass, before accessing abortion care.Physicians cannot use telemedicine to prescribe pills for medication/non-surgical abortion.The state’s Medicaid program does not cover abortion care, and state healthcare plans offered under the Affordable Care Act only cover abortion if the woman’s life is endangered, or in case of rape or incest. May 24, 2019: NPR posted an article titled: “Missouri Governor Signs Ban On Abortion After 8 Weeks of Pregnancy”. It was written by Bobby Allyn. From the article: Missouri Gov. Mike Parson signed a bill on Friday that criminalizes abortions in the state after eight weeks of pregnancy, the latest in a series of sweeping restrictions passed by Republican-controlled legislatures that now threaten nearly 50 years of federal protections for abortion.Under the law, any person who performs an abortion after eight weeks – which is often before many women know they are pregnant – could be charged with a Class B felony punishable by five to 15 years in prison.The final version of the legislation does not have exceptions for victims of rape or incest. It does have a carve-out for cases of medical complications……The Missouri law stipulates that if an abortion within the eight-week window is performed, the woman needs to be given the opportunity to view an ultrasound, but it is not mandatory that she view it.The bill, HB 126, known as the Missouri Stands for the Unborn Act, passed both chambers of the General Assembly last week. Under the bill, women will be able to terminate a pregnancy after eight weeks only if they meet the law’s definition of a medical emergency, which lawmakers defined as something that “so complicates the medical condition of a pregnant woman as to necessitate the immediate abortion of her pregnancy to avert the death of the pregnant woman or for which a delay will create a serious risk of substantial and irreversible physical impairment.”Before the bill’s passage, protestors’ shouts of “When you lie, people die” filled the chamber before they were escorted out of the building… May 24, 2019: Senator Amy Klobuchar tweeted: “The coordinated attack on women’s health care continues. This is dangerous and unconstitutional, and we must fight back.” The tweet included a link to a New York Times article titled: “Missouri Governor Signs Bill Outlawing Abortion After 8 Weeks”. THIS BLOG WILL BE UPDATED WHENEVER RELEVANT INFORMATION IS FOUND. A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three 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!...
- A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Two
  March 27, 2019health insurance / Out of SpoonsImage by Gordon Johnson from Pixabay This is part two of my series of blogs about the ways that the GOP, under President Trump, attempted to destroy Obamacare. You may want to read part one before jumping into this blog post. This blog post details the shenanigans that happened in 2018, during the 115th Congress. The GOP had the Presidency, the majority in the U.S. Senate and the majority in the U.S. House of Representatives. One of the things I noticed when the GOP got started (last year) on attempting to destroy Obamacare was that they extended their efforts beyond it. The GOP also tried to prevent poor people, disabled people, and those with pre-existing conditions from being able to afford the health care they needed. The GOP tried to cut off funding for women’s health care (including reproductive care and abortion). They even went after Medicaid, Medicare, and other established health care options for poor people. January 5, 2018: Governor C.L. “Butch” Otter (Republican) posted a News Release on his official website. From the News Release: Governor C.L. “Butch” Otter directed the Idaho Department of Insurance today to use flexibility provided by the Trump administration to develop guidelines under which Idaho health insurance carriers can offer coverage plans at significantly lower costs.At the annual Associated Press Legislative Preview in the Capitol today, Governor Otter signed Executive Order 2018-02 instructing Insurance Director Dean Cameron to seek creative ways outside the restrictions of the Affordable Care Act to make health coverage more affordable for Idaho residents……Cameron said he hopes insurance plans from Idaho carriers can be available as early as March to reduce costs for essential health-care coverage by 30 to 50 percent. Such plans would not qualify for an Obamacare subsidy on premium payments but carriers involved must agree to continue offering plans through the Your Health Idaho insurance exchange, where federal subsidies will continue to be available.Idaho sought greater flexibility from Health and Human Services “to continue innovating and creating new products under our State law,” in a March 10, 2017 letter from Governor Otter to then-Secretary Tom Price.President Trump also issued an executive order on January 20, 2017 – the day of his inauguration – aimed at minimizing the economic burden of the Affordable Care Act “Pending Repeal.” It stated that the federal government should “take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.”Cameron said those steps, and elimination of the individual mandate, should enable the State to take actions to keep Idahoans from having to pay too much for insurance, resort to unconventional alternative treatments or simply go without coverage. “We believe we have the authority already,” he said. “We want to act quickly.” January 10, 2018: Financial Times posted a very long, detailed, heartbreaking article titled: “Why are so many Americans crowdfunding their healthcare?” It was written by Barney Jopson. From the article: …Then there is the issue of money. In the US, where healthcare is not a human right, any serious illness comes with a financial shock. The average cost of hospital stays for cancer patients in 2015 was $31,290, according to government figures – about half that year’s median household income. The most common form of childhood cancer costs on average $292,000 to treat, says St. Jude Children’s Research Hospital in Memphis, Tennessee.For the most fortunate Americans, these costs are covered by comprehensive insurance plans. For millions of others, they are a potentially crippling burden. After Isabella’s diagnosis, [Claudia] Koziner [Isabella’s mother] took unpaid family leave to care for her daughter, reducing the family to a single income. She and Isabella were able to stay on the health plan provided by her employer, ensuring they did not join the 28 million Americans who lack any health insurance. Instead, they are part of a larger group that is underinsured. The family pay $15,000 each year as part of cost-sharing arrangements with the insurer, then have to cover everything it will not, ranging from protein shots to hearing tests to two-way ambulance trips that can cost up to $3,000……For Isabella and her parents, crowdfunding has alleviated financial pressure at an agonizing time. “The fact that at least, at this point in time, we don’t have to stress about finances is huge,” says Koziner. I don’t even know how we’d get by.” But its spread is also a symptom of a particularly American affliction: a flawed, costly healthcare system that offers some of the best care in the world to those who can afford it, while forcing millions of others to either plunge into debt or leave their illnesses untreated.The rise of online fundraising for medical expenses brings its own troubling consequences, replicating some of the inequalities already dividing the country by forcing people to compete for funds……It should be no surprise that healthcare proved fertile territory [for GoFundMe]. Crowdfunding is also growing in the UK, Australia, and Canada but is generally confined to treatments not covered by public healthcare systems. In the US, it is often about paying for the basics. American medicine is big business and the US spends more on it than any other nation, yet is the only developed country that lacks universal healthcare coverage. A fifth of US household spending went on healthcare in 2013, compared with just 4 per cent in the EU, according to Eurostat, a statistics agency.Despite this, Americans are in worse health. Judged on measures including life expectancy and infant mortality, the US ranked last for healthcare outcomes among 11 high-income countries in a study last year by the Commonwealth Fund, a New York-based research foundation……Crowdfunding may also perpetuate existing inequalities. Well-off people can tap into networks of well-off friends who have money to donate in a crisis. Poorer people tend to have ties to poorer people with less to give. Kenworthy and co-researcher Lauren Berliner warn that results can also be distorted by prejudicial notions of “deservingness” based on race, class and immigration status…… No business sector, not even Wall Street, has shelled out more on lobbying than pharmaceuticals and health products. From 1998 to 2017 it spent $3.7bn influencing policymakers, according to the Center for Responsive Politics. Physicians have also preserved their generous earnings. Jobs in medicine and dentistry accounted for none of the 10 highest-paying roles in American in 2016, according to Forbes, with anesthesiologists earning an average salary of $269,000, surgeons $252,910, and family doctors $200,810……By the time Obama became president, voter frustration with the system’s dysfunction was such that the industry decided it had to support his push for change in order to influence it. Obamacare’s signature achievement was to reduce the number of uninsured Americans – but in doing so it cemented the primacy of private insurers……Half of the population have private policies provided by employers, and 7 percent have plans purchased individually, including on Obamacare marketplaces. Government programs for the poor, elderly and veterans cover about 35 percent of the population.Nine percent have no health insurance, because they can’t afford it or don’t see it as a priority. According to the Commonwealth Fund, three out of 10 working-age Americans were underinsured in 2016 (meaning they had high out-of-pocket healthcare costs relative to their incomes) – 41 million people… January 11, 2018: The Center for Medicare and Medicaid Services (CMS) sent a letter to State Medicaid Directors. From the letter: The Centers for Medicare & Medicaid Services (CMS) is announcing a new policy designed to assist states in their efforts to improve Medicaid enrollee health and well-being through incentivizing work and community engagement among non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability. [1] Subject to the full federal review process, CMS will support state efforts to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility or coverage for certain adult Medicaid beneficiaries in demonstration projects authorized under section 115 of the Social Security Act (the Act). Such programs should be designed to promote better mental, physical, and emotional health in furtherance of Medicaid program objectives. Such programs may also, separately, be designed to help individual families to rise out of poverty and attain independence, also in furtherance of Medicaid program objectives [2]……[1] States will have the flexibility to identify activities, other than employment, which promote health and wellness, and which will meet the state’s requirements for continued Medicaid eligibility. These activities include, but are not limited to, community service, caregiving, education, job training and substance use disorder treatment.[2] Section 1901 of the Social Security Act authorizes appropriations to support State Medicaid programs: “For the purpose of enabling each State, as far as practicable under the current conditions in such State, to furnish (1) medical assistance on behalf of families with dependent children of aged, blind, or disabled individuals, whose income and resources are insufficient to meet the costs of necessary medical services, and (2) rehabilitation and other services to help such families and individuals to attain or retain capability for independence or self-care[.]”… January 11, 2018: The New York Times posted an article titled: “Trump Administration Says States May Impose Work Requirements for Medicaid”. It was written by Robert Pear. From the article: The Trump administration said on Thursday that it would allow states to impose work requirements in Medicaid, a major policy shift that moves toward fulfilling a conservative vision for one of the nation’s largest social insurance programs for low-income people.Federal officials said they would support state efforts to require able-bodied adults to work or participate in other “community engagement activities” as a condition of eligibility for Medicaid……Ms. [Seema] Verma [Administrator of the federal Centers for Medicare and Medicaid Services] said the Trump administration was responding to requests from Medicaid officials in 10 states that wanted to run demonstration projects testing requirements for work or other types of community engagement like training, education, job search, volunteer activities and caregiving.Under the new policy, Trump administration officials would allow work requirements in Medicaid somewhat similar to those already imposed in other programs like food stamps, now known as the Supplemental Nutrition Assistance Program, and the welfare program known as Temporary Assistance for Needy Families……The Medicaid proposals came from Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin. Several other states are considering work requirements……Advocates for Medicaid beneficiaries said the new policy was likely to be challenged in court if people were denied coverage for failure to meet a state’s work requirement.Federal law gives the secretary of health and human services broad authority to grant waivers for state demonstration projects that “promote the objectives” of the Medicaid program. In the past, federal officials said that work was not among those objectives.But Trump administration officials said on Thursday that work requirements were consistent with the goals of Medicaid, because work and work-related activities could improve the health of Medicaid beneficiaries….…The Trump administration said that states imposing work requirement must have plans to help people meet those requirements and should help arrange job training, child care, and transportation as needed. But, it said, states cannot use federal Medicaid funds to pay for such “supportive services”… January 11, 2018: The New York Times posted an opinion piece titled: “Trump’s Medicaid Work Requirement Will Backfire.” It was written by Jared Bernstein (senior fellow at the Center on Budget and Policy Priorities) and Hanna Katch, (a health policy expert at the center and a former Senate health policy staff member and a California Medicaid administrator). From the opinion piece: Just because President Trump and the Republican Congress were unable to pass health care legislation that would have unwound the coverage benefits of the Affordable Care Act doesn’t mean such attacks are behind us. To the contrary, Republicans are now making an end run around Congress to accomplish one of their harshest goals: kicking economically vulnerable people off Medicaid.The administration’s new approach – one that no administration before it has taken – is to provide waivers to states that allow them to impose work requirements for Medicaid benefits. Thus far, the Centers for Medicare and Medicaid Services has received requests for waivers from 10 states. C.M.S. released guidance on Thursday describing how states can institute these work requirements.Even before Thursday, C.M.S. had unilaterally changed the standards a waiver must meet to accord with Medicaid’s core mission – specifically, that whatever they do, states must increase and strengthen health coverage for people of limited means. Now the administration will be considering waivers that are likely to deprive thousands of low-income people of health care.Some of these people will lose coverage because they can’t find jobs to fulfill the work requirements. Others will lose it because they fail to complete paperwork proving they’re working or that they qualify for exemptions. For example, people with mental illness, addiction, or chronic disease often struggle to meet bureaucratic demands; in programs that already demand that beneficiaries work, such individuals have often been punished for falling short on work requirements even though they’re supposed to qualify for exemptions……People losing coverage could suffer severe harm. A study of Medicaid expansion in Kentucky and Arkansas found that it led to significant gains in access to care, financial security and health, with increases in the share of low-income adults going for checkups, getting regular care for chronic conditions and reporting that they are in excellent health. It also found large decreases in the share of people struggling to pay medical bills and relying on hospital emergency rooms for care. Under the new waivers, these gains will be reversed.It is also essential to recognize that Medicaid work requirements won’t work. There’s no evidence that Medicaid discourages work, which comports with common sense: You can’t pay rent or buy groceries with health coverage. About 80 percent of able-bodied adult Medicaid recipients are part of working families (that is, either they or their spouses work), and about 60 percent work themselves. Among adults on Medicaid who don’t work and could be subject to the work requirement, more than a third have a chronic health problem or disability, about half take care of family or go to school, and just under 10 percent can’t find work.It’s far more likely that Medicaid work requirements will backfire, at least in terms of improving beneficiaries’ living standards. By providing coverage for workers in jobs that are unlikely to provide such benefits, and by helping to stabilize the finances of people with illnesses, Medicaid has been found to help people stay employed or find work.Of course, not all the Republicans’ efforts to shrink Medicaid are occurring through executive, as opposed to congressional, action. The new tax law’s repeal of the Affordable Care Act’s individual mandate could, according to the nonpartisan Congressional Budget Office, cut five million from the Medicaid rolls by 2027. That’s because, absent the mandate, fewer low-income people will find out that they’re eligible for Medicaid, especially in expansion states… January 12, 2018: Courier Journal (Part of the USA Today Network) posted an article titled: “Kentucky first to win federal approval to roll back Medicaid expansion under Obamacare”. It was written by Deborah Yetter. From the article: Calling it an “exciting day,” Gov. Matt Bevin on Friday said federal authorities have given Kentucky broad power to reshape its Medicaid program, making it the first state in the nation to win such approval under rules that allow states to include work requirements for some recipients……The news was released Friday by U.S. Rep. John Yarmuth just minutes before Bevin’s announcement. Yarmuth called the move “dangerous and irresponsible,” saying it will cause tens of thousands of Kentuckians to lose health coverage.But Bevin dismissed such comments and said the plan will transform Medicaid.“It will be a model for the nation,” he said.But advocacy groups disagreed, including Kentucky Voices for Health, a coalition of health organizations that had opposed the changes as unnecessary and harmful to low-income people who rely on Medicaid for health care……The approval comes 16 months after Bevin, a Republican elected in 2015, announced sweeping changes to the $10 billion federal-state program that provides health care for 1.4 million low-income and disabled Kentuckians, arguing it is “not sustainable”.And it comes one day after the Centers for Medicaid and Medicare announced it has approved controversial new “community engagement” rules to allow stats to require some Medicaid beneficiaries to work or volunteer in order to get health coverage……The program will be phased in starting in July, officials said Friday.Bevin’s plan would require some adults to work or volunteer at least 20 hours a week or be in school or job training to keep health benefits. He has said it will inject more personal responsibility into the government health plan and believes participants should have “some skin in the game.”……[Leonard] Cuello [a lawyer with the Washington-based National Health Law Program] said Medicaid law is designed purely as a health law and efforts by states to add a work requirement, as authorized by federal aid programs such as food stamps, are not allowed.“Medicaid is a healthcare program,” he said. “It’s about health services. It’s not about employment encouragement.”……Advocates say the changes will cause up to 95,000 Kentuckians to lose Medicaid health coverage, according to the administration’s own calculations…. January 12, 2018: Rewire News posted an article titled: “Despite Republican Claims, Medicaid Work Requirements Would Hurt People With Disabilities”. It was written by Robyn Powell. From the article: …Republicans have unwaveringly asserted that work requirement will only apply to people who are “able-bodied.” This claim is simply untrue. The disability exception promulgated in the new rules only covers people who receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). In other words, anyone who has a disability and does not receive SSI or SSDI would likely need to adhere to the new work requirements, should their state implement them……To receive SSI or SSDI, a person must meet the Social Security Administration’s (SSA) stringent definition of disability: “the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” Put differently, one’s disability must be deemed so significant that they are unable to work in any type of job.According to Rebecca Cokley, senior fellow at the Center for American Progress, “Cancer survivors, some chronic conditions, people with mental health disabilities, and those who are substance abuse survivors will likely still be impacted, as often these are folks who get Medicaid but don’t meet the qualifications for [SSI or SSDI],”Qualifying for SSI or SSDI is no small feat and most people who endure the lengthy application process do not ultimately receive benefits. In fact, fewer than four in ten applications for SSI and SSDI are ultimately approved. Moreover, applicants often are forced to wait years and go through many appeals processes before receiving SSI or SSDI; 10,000 people died last year while waiting for their appeal to process. Nevertheless, people with disabilities “will be forced to navigate a byzantine bureaucracy to qualify [for the work requirement] exceptions,” [Ari] Ne’eman [an Obama administration appointee to the National Council on Disability] said. January 16, 2018: Los Angeles Times posted an article titled: “Number of Americans without health insurance grows in Trump’s first year, new figures show”. It was written by Noam N. Levey. From the article: The number of Americans without health coverage, which declined for years after passage of the Affordable Care Act, shot up in President Trump’s first year in office, according to data from a new national survey.At the end of 2017, 12.2% of U.S. adults lacked health insurance, up from 10.9% at the end of 2016, as President Obama was completing his final term.The increase of 1.3 percentage points, although modest, marks the first time since at least 2008 that the share of adults without insurance increased from the previous year, according to the report from Gallup, which conducts a widely followed survey asking Americans about their health coverage.The increase indicates that 3.3 million Americans lost health coverage in 2017, Gallup concluded.The decline in coverage was most pronounced among slices of the population on which the Obama administration and its allies had focused enrollment efforts; young adults, blacks, Latinos and households making less than $36,000 a year, Gallup found.The losses follow years of historic insurance gains driven by the healthcare law’s expansion of coverage, which started being fully implements in 2014……A recent study of data from two states that have dramatically expanded coverage, Arkansas and Kentucky, found, for example, that low-income patients with chronic illnesses are now much more likely to seek recommended care.By contrast, there has been significantly less improvement among such patients in Texas, which has not expanded coverage fully through the healthcare law.But many Republicans, including leading Trump administration officials, have dismissed coverage gains as meaningless. They have argued that the coverage provided under the healthcare law is unaffordable – because of out-of-pocket costs are too high – or that patients face too many restrictions in their choice of doctors.Trump came into office last January pledging to roll back the law, common called Obamacare. His administration undertook a sustained campaign throughout 2017 to discredit the law while congressional Republicans tried to repeal it.The repeal campaign failed. But it helped weaken health insurance markets around the country, in regions that already had few insurers and higher prices than the rest of the country.At the same time, the Trump administration dramatically cut outreach and advertising efforts… January 19, 2018: Rewire News posted an article titled: “For People With Disabilities, Trump’s First Year Has Threatened Nearly Every Facet of Life”. It was written by Robyn Powell. From the article: …One of the main attacks on autonomy for people with disabilities was Republican’s fight against the Affordable Care Act (ACA), egged on by the President. Over the summer, people with disabilities, particularly members of the grassroots ADAPT, gained national attention for successfully battling the repeated attempts to repeal the ACA. Beginning with a “die-in” staged outside the office of Sen. Mitch McConnell (R-Ky.) in late June, ADAPT held dozens of direct actions – at both the U.S. Capitol and congressional offices across the country. For people with disabilities, saving the ACA was a matter of life and death.Notably, each attempt by the GOP to repeal the ACA included significant cuts to Medicaid. This threatened not only health care for people with disabilities, but also access to necessary supports that enable us to live in our communities. Medicaid is the primary health insurer of children and adults with disabilities. It covers services that other commercial health insurance does not, such as personal care assistants (PCAs) who provide in-home care to people with disabilities. Without PCAs, some people with disabilities cannot work, go to school, or be contributing members of their community.Last week, the Trump administration delivered another blow to health care by allowing states to impose work requirements for people who receive Medicaid. Despite the GOP’s claims, Medicaid work requirements will likely harm people with disabilities, and will result in fewer disabled people receiving Medicaid……In December, the GOP passed – and Trump signed into law – the Tax Cuts and Jobs Act of 2017, harking this tax reform bill a win for everyone. While this bill will leave wealthy people far better off, people with disabilities will likely face greater tax burdens and decreased opportunities to live the life they choose. The bill includes massive cuts to Medicare and other safety-net programs and eliminates tax incentives for small businesses to modify their facilities to ensure accessibility for people with disabilities. Moreover, because the law includes a repeal of the ACA’s individual mandate, health insurance premiums will undoubtedly climb, leaving them unaffordable for many – including people with disabilities… January 22, 2018: Covered California posted information titled “Covered California Announces Continued Strong Enrollment and Reminds Consumers That Penalty Remains in Place Through 2018”. From the information: The Patient Protection and Affordable Care Act’s requirements that consumers have health insurance remains in place, and consumers may face stiff tax penalties if they are not covered in 2018.A recent study estimates 70 percent of consumers, who are uninsured and eligible for financial help, could purchase health insurance coverage for less than the price of the tax penalty.Most consumers are paying less in monthly premiums than they did a year ago.More than 342, 000 consumers have newly enrolled during the current open-enrollment period, which remains ahead of last year’s pace, and continues in California through Jan. 31. …Covered California also reminded consumers that the Affordable Care Act’s individual shared responsibility payment, often called the individual mandate, remains in place throughout calendar year 2018. Consumers who do not have health insurance could face stiff tax penalties if they are not covered. These penalties are a minimum of $695 per adult and $347.50 per child, up to $2,085 per family, or at least 2.5 percent of annual household income – whichever is greater (for an estimated maximum penalty of $3,816 per individual and $19,080 for a family of five). The recent tax bill removes the penalty but it does not go into effect until 2019……A recent Covered California analysis found that the net monthly premiums for enrollees who receive financial help are on average 10 percent lower than what new and renewing consumers paid last year. The lower prices are a result of more financial help being available for consumers who qualify for assistance. The Affordable Care Act is designed to protect consumers by providing more premium tax credits when premiums rise. And for the many Californians in the individual market who do not get financial help, the robust competition has meant that for many, premium increases have been kept in the single digits… February 9, 2018: Covered California posted information titled: “Covered California Finishes Fifth Open Enrollment Strong – New Sign-ups of 423,484 up 3 Percent Over Last Year.” From the information: More than 50,000 people selected health insurance plans through Covered California in the final three days of open enrollment.Covered California has now served more than 3.4 million consumers since 2014.The number of renewing enrollees dropped slightly, in part due to Covered California encouraging unsubsidized Silver plan enrollees to shop off-exchange.Consumers made smart choices for 2018, picking Gold plans in many cases to get the best value for themselves and their families.Subsidized consumers paid less for health coverage in 2018 than 2017 due to the protective effect of their subsidy rising to offset higher premiums, while unsubsidized consumers in the individual market – both in and out of Covered California – saw their costs rise.Without action by Congress, unsubsidized consumers nationwide could see their costs rise steeply in 2019 and find coverage increasingly unaffordable. February 14, 2018: Bloomberg posted an article titled: “Ignoring Obamacare Rules, Idaho ‘Freedom’ Plans Come With Limits”. It was written by Zachary Tracer. From the article: After Idaho’s Republican governor promised to find creative ways to get around Obamacare, one health plan in the state plans to offer skimpy coverage that may violate many of the law’s protections for patients.Blue Cross of Idaho said Wednesday that it will offer insurance plans that don’t comply with some Affordable Care Act requirements. The “Freedom Blue” coverage is a way to give some people lower premiums upfront in exchange for less comprehensive coverage.Others will pay more — the plans have limits on annual medical spending and will charge sicker people higher premiums or deny them coverage in some cases. Those policies are specifically forbidden by the 2010 law.The move sets up a potential conflict with the federal government. While President Donald Trump has said he opposes the law and has taken steps to undermine it, the administration will have to decide whether to enforce legal requirements that remain on the books……If the department [of Health and Human Services] doesn’t act, it could be up to the courts to resolve whether Idaho is violating the law……In early January, Idaho Governor Butch Otter directed the state’s insurance regulator to find “creative ways” for health insurers in the state to offer more affordable coverage. Otter said the state planned to use flexibility offered by the Trump administration in an executive order, and that it had authority to do so. The insurance regulator issued guidelines for the plans later that month……The Idaho plan believes it’s following the flexibility it has under the law……The proposed plans have a $1 million annual per-person limit to how much care the insurer will pay for. The plans have many of the same general benefits as ACA plans, though one won’t cover maternity care. They can also charge more to people who are sicker after asking them extensive questions about their health.While such policies were banned by the Affordable Care Act, Idaho plans to use the law as a backstop. If individuals end up with medical expenses that exceed the $1 million limit in the non-Obamacare plans, Idaho will require insurers to help them move into ACA plans, which don’t have limits on medical spending. February 15, 2018: The New York Times posted an article titled: “New Health Secretary Faces First Test as Idaho Skirts Federal Law”. It was written by Robert Pear. From the article: Alex M. Azar II, the new secretary of health and human services, said Thursday that he would closely scrutinize a plan by Idaho to allow the sale of insurance that does not comply with the Affordable Care Act, an early test of how he will enforce a law he opposes.But he said it was too early to know what action he might take……Democrats in Congress, as well as the American Cancer Society and other groups representing patients, say the Idaho plan would allow insurers to discriminate against people with pre-existing medical conditions, in defiance of the federal law……The plan presents Mr. Azar with a choice that he could face frequently in his new job: whether to try to shore up the health law or to “let Obamacare fail,” as President Trump has threatened to do. His decisions could have significant consequences both for consumers and for Republicans in the midterm elections……Mr. Azar described Idaho’s plan as “a cry for help” by a state seeking more affordable coverage options for its residents. He said the Idaho program would be subject to “searching review for compliance” with federal law……Idaho residents will still be able to obtain coverage that complies with the Affordable Care Act on the state’s health insurance exchange, Mr. Crapo said. But Idaho will allow other options, outside the exchange.The Republican governor of Idaho, C.L. Otter, known as Butch, issues an executive order last month to combat what he called “the overreaching, intrusive nature of Obamacare.” And on Jan. 24, the state Insurance Department issued guidelines for the sale of insurance policies that do not meed coverage requirements of the Affordable Care Act.Idaho’s new “state-based health benefit plans” will have to carry a disclaimer: “The policy is not fully compliant with federal health insurance requirements.”Insurers in Idaho could, in some cases, charge different rates based on a person’s health status or claims experience. In addition, insurers would not have to comply with provisions of the federal law limiting out-of-pocket costs, and they could impose caps on the dollar amount of benefits available to consumers.Dean L. Cameron, the director of the Idaho Department of Insurance, said in an interview on Thursday that insurers could start selling the new state-based health plans as early as April… February 20, 2018: CNN Money posted an article titled “Trump administration unveils alternative to Obamacare”. It was written by Tami Luhby. From the article: Officials Tuesday proposed regulations that will make it easier to obtain coverage through short-term health insurance plans — which don’t have to adhere to the Affordable Care Act’s consumer protections — by allowing insurers to sell policies that last just under a year. The new rules stem from an executive order President Trump signed in October aimed at boosting competition, giving consumers more choices and lowering premiums……The proposal would reverse an Obama administration decision to limit the duration of short-term health plans to no more than 90 days in order to make them less attractive.Such plans could roil the Obamacare market, drawing healthier consumers away from the exchanges and pushing up the premiums for those who remain.Short-term health plans, which have been available for years and were originally designed to fill a temporary gap in coverage, are likely to be cheaper than Obamacare policies. But that’s because they are allowed to exclude those with pre-existing conditions and base rates on an applicant’s medical history, unlike plans sold on the Obamacare exchanges.Also, short-term plans don’t have to offer comprehensive coverage. Typically, they don’t provide free preventative care or maternity, prescription drugs and mental health benefits. They can also impose annual or lifetime limits, meaning they may only pay out a set amount — often $1 million or less — leaving the policyholder on the hook for the rest. And, unlike Obamacare policies, they don’t have to cap consumers’ cost-sharing burden at $7,350 for 2018……Also, insurers aren’t required to renew the policies so those who become sick could find themselves unable to sign up again for the same plan……The proposed regulations are the latest step in the Trump administration’s quest to weaken Obamacare. Last month, officials unveiled a proposed rule that would make it easier for small businesses — and some self employed folks — to band together and buy health insurance. That proposal also stemmed from Trump’s executive order and is designed to broaden access to what are known as association health plans. February 26, 2018: CNN posted an article titled: “9 million fewer Americans expected to have health insurance in 2019”. It was written by Tami Luhby. From the article: About 9 million fewer Americans will have health insurance next year, thanks to the Trump administration and Republicans in Congress, a new report estimates.Congress’ elimination of the individual mandate, which takes effect in 2019, and a trio of moves by President Donald Trump are expected to fuel the decrease, the Urban Institute said.Trump’s actions include the discontinuation of federal support of a key Obamacare subsidy, the reduction of advertising and assistance for Obamacare’s open enrollment season and the proposed expansion of short-term insurance policies. The Congressional Budget Office does not consider consumers with such policies to be insured……The individual mandate, one of Obamacare’s least popular provisions, requires nearly all Americans to get coverage or pay a penalty. The CBO estimated in November that 4 million fewer people would be insured in 2019 because healthier people would be less likely to buy policies without the mandate in place……The Urban Institute estimated that the mandate’s elimination, as well as the reduced federal support of open enrollment, would leave 6.4 million fewer people with coverage by 2019……About 2.5 million people who would have been otherwise insured will opt for short-term policies next year instead, the Urban Institute estimates.Combined, the elimination of the individual mandate and the expansion of short-term plans will likely cause premiums for Obamacare policies to increase an average of 18.2% next year in the 43 states that do not prohibit or limit such policies, according to the Urban Institute. February 28, 2018: Vox posted an article titled: “20 states file a new lawsuit arguing Obamacare is illegal”. It was written by Sarah Kliff. From the article: Twenty state attorney generals have filed a new lawsuit that – like the many lawsuits before it – aims to take down the Affordable Care Act.The suit, filed in a Texas district court on Tuesday, makes a new legal argument that relies on Congress’s recent repeal of the individual mandate penalty……Let’s start with the actual argument at play here. This lawsuit starts from Congress’s recent decision to ax Obamacare’s penalty for not carrying health insurance, reducing the fine from $695 to $0 – essentially getting rid of the provision.In previous rulings, the brief argues, the Supreme Court has stated that this mandate is crucial to making the Affordable Care Act work. The mandate gets healthy people into the insurance market, thus allowing the Affordable Care Act to also require insurers to offer coverage to those with costly pre-existing conditions, too.With the individual mandate penalty killed, the lawsuit argues that the entire law is no longer workable and ought to be struck down……Or, as the lawsuit itself puts it: “Once the heart of the ACA – the individual mandate – is declared unconstitutional, the remainder of the ACA must also fall.”……This lawsuit is brought by 20 different states, and they no doubt decided to bring their case in a district court that they thought might be more conservative, and more sympathetic to their arguments… The lawsuit is called “State of Texas, et. al. v United States of America, et. al.” It was filed in the United States District Court Northern District of Texas. Full text of the lawsuit can be found on the Texas Attorney General website. Plaintifs include: Texas (Attorney General Ken Paxton – Republican)Wisconsin (Attorney General Brad Schmiel – Republican)Alabama (Attorney General Steve Marshall – Republican)Arkansas (Attorney General Leslie Rutledge – Republican)Arizona (Attorney General Mark Brnovich – Republican)Florida (Attorney General Pam Bondi – Republican)Georgia (Attorney General Christopher Car – Republican)Indiana (Attorney General Curtis Hill – Republican)Kansas (Attorney General Derek Schmidt – Republican)Louisiana (Attorney General Jeff Landry – Republican)Maine (Governor of Maine Paul LePage – Republican)Mississippi (Governor Phil Bryant – Republican)Missouri (Attorney General Josh Hawley – Republican)Nebraska (Attorney General Doug Peterson – Republican)North Dakota (Attorney General Wayne Stenehjem – Republican)South Carolina (Attorney General Alan Wilson – Republican)South Dakota (Attorney General Marty Jackley – Republican)Tennessee (Attorney General Hubert Slattery III – Republican)Utah (Attorney General Sean Reyes – Republican)West Virginia (Attorney General Patrick Morrisey – Republican) Defendants include: United States of AmericaUnited States Department of Health and Human Services, Alex Azar, in his Official Capacity as Secretary of Health and Human ServicesUnited States Internal Revenue Service and David J. Kautter, in his Official Capacity as Acting Commissioner of Internal Revenue March 1, 2018: Health Affairs posted a survey titled “Eliminating the Individual Mandate Penalty in California: Harmful but Non-Fatal Changes In Enrollment And Premiums”. It was written by John Hsu, Vicki Funs, Michael E. Chernew, Alan M. Zaslavsky, William Dow, and Joseph P. Newhouse. The California Health Care Foundation provided funding for the 2017 survey and data analysis. The survey was done in partnership with Covered California. From the survey: The federal tax reform act of December 2017 eliminated the penalty for noncompliance with the Affordable Care Act’s (ACA) individual mandate (also known as the shared responsibility requirement) starting in 2019. This legislative change has highlighted uncertainty about the penalty’s importance in inducing lower-risk individuals to purchase insurance, to purchase insurance, and the potential for higher premiums in the individual insurance market should they not do so.The Congressional Budget Office and the Joint Committee on Taxation (CBO/JCT) estimated that within one year, eliminating the penalty would leave four million fewer individuals insured nationwide, including three million fewer with individual market insurance. Moreover, the higher risk profile of the remaining insured would drive up individual insurance market premiums by 10 percent. CBO/JCT also predicted that over time more enrollees would drop out of the insurance market, partly due to the rising premiums, resulting in five million fewer insured in 2027 compared with baseline estimates without the repeal.Proponents of the mandate repeal suggested that the CBO/JCT methodology is flawed because it overstates the importance of the mandate for coverage. Another recent analysis suggests that the size of the mandate penalty had little effect on coverage in 2014 and 2015, but ignores any generalized “woodwork” effect of the mandate. Importantly, the effect of eliminating the penalty on market stability depends both on 1) the number of people who no longer purchase insurance, and 2) whether these people are healthier than those retaining insurance and thus have below-average medical costs. If most enrollees continue to purchase insurance, or if those who do not purchase have similar average risk to those who do purchase, there will be less impact on premiums. From here, the survey digs into data collected in a random sample of California enrollees in the individual market. A total of 3,010 people responded who either purchased individual insurance market plans through the Covered California marketplace or outside the marketplace. Respondents were asked whether they knew that they would have to pay a tax penalty if they did not have insurance coverage, and if so, whether they would have purchased health insurance coverage this year (2017) if there were no penalty. The survey was conducted between May and September 2017, prior to the passage of the tax reform bill. 18 percent of enrollees in California’s individual market in 2017 say they would not have purchased insurance in the absence of a penalty. The substantial majority of lower-risk enrollees would still have purchased.Based on this changing mix, the surveyors estimate that eliminating the mandate penalty would have caused premiums to rise 5 percent to 9 percent in California’s individual market plans.Overall, 91 percent of individual market enrollees in this California sample were aware that there was a mandate penalty, and 18 percent (or almost one in five enrollees) said they would not have purchased insurance in 2017 if the penalty had not existed.This reduction (about 378,000 fewer enrollees in California) is comparable to the CBO/JCT estimate of enrollment reductions nationally in the first year following the elimination of the mandate penalty, but larger than the 7 percent reported in an October 2017 nationwide Kaiser Health Tracking Poll.Enrollees with the lowest levels of predicted medical spending were more likely to say they would not have purchased insurance in 2017 in the absence of the penalty, compared with those at higher levels of predicted spending.For example, 30 percent and 21 percent of those in the lowest two deciles of predicted spending said they would not have purchased insurance in the absence of the penalty, compared to 13 percent and 10 percent of those in the top two deciles of predicted spending.At each level of predicted spending, the majority of respondents (70 percent to 90 percent) would likely have purchased insurance in the absence of the mandate penalty.Eliminating the mandate penalty could matter less in California than in other states because California has one of the most stable individual markets in the nation with a more favorable risk mix than other states, as reflected in the average risk scores published by the Center for Consumer Information & Insurance Oversight.California has implemented a number of policies to reduce adverse selection into and within the market. For example, California was one of 11 states that prohibited the sale of ACA non-compliant plans in 2014, which likely improved the favorability of the individual market risk pool. It was one of five states to mandate some kind of alignment of plans sold on and off the public marketplace by requiring that all plans sold on-markeptlace have a mirrored product sold off-marketplace.Relative to other states, California has invested heavily in outreach and education efforts to increase insurance uptake, outreach, and education efforts to increase insurance uptake, emphasizing reasons other than the mandate for buying insurance such as financial and health protection. March 8, 2018: Covered California released an analysis titled: “Individual Markets Nationally Face High Premium Increases in Coming Years Absent Federal or State Action, With Wide Variation Among States”. From the Highlights of the analysis: All states’ individual markets risk higher than normal premium increases – ranging from 35 to 90 percent over three years – due to continued uncertainty at the federal level, but state variation informs understanding of local risks.Premium increases in the individual markets will likely range from 12 to 32 percent in 2019, and cumulative increases from 2019-2021 will range from 35 percent to more than 90 percent.Increases are on average more than double the rate of medical inflation as a result of healthier consumers leaving the individual market.The report identifies 17 states that are more likely – because of their historic mix and enrollment – to have cumulative premium increases of 90 percent or more and 19 additional states are at a higher risk of experiencing hikes of 50 percent.Policy actions could both lower premiums and promote more plan competition by reducing uncertainty – with independent actuarial analysis finding that reinsurance or similar programs could cut premium increases in half, bringing them to single digits in many states. The analysis has details about premium costs in a “State-by-State Interactive Mapping of Premium Increase and Instability Risk” map. It is color coded to indicate which category each state falls into: Significant Marketplace Risk: These states could face a possible 35% premium increase by 2021): Washington, Oregon, California, Nevada, Utah, Colorado, Nebraska, North Dakota, South Dakota, Minnesota, Kentucky, Massachusetts, Rhode Island, and Connecticut.High Marketplace Risk: These states could face a possible 50% premium increase by 2021): Montana, Idaho, Wyoming, Arizona, New Mexico, Kansas, Iowa, Missouri, Illinois, Indiana, Georgia, Florida, Virginia, Maryland, Delaware, New York, Vermont, and MaineCatastrophic Marketplace Risk: These states could face a possible 90% premium increase by 2021): Texas, Oklahoma, Arizona, Louisiana, Mississippi, Alabama, Tennessee, North Carolina, South Carolina, Wisconsin, Michigan, Ohio, West Virginia, Pennsylvania, New Jersey and New Hampshire.It doesn’t say why Alaska and Hawaii are not on the map, or what level of marketplace risk they face. March 8, 2018: New York Magazine posted an article titled: “White House Tells Idaho to Sabotage Obamacare More Subtly”. It was written by Eric Levitz. From the article: In January, Republicans in Idaho decided that if Congress wasn’t going to repeal the Affordable Care Act, they would just have to repeal it themselves. Governor C.L. “Butch” Otter signed an executive order that nullified a whole host of ACA regulations: Insurers in the Gem State would now be able to sell health-care plans that didn’t cover maternity care, mental illness, or other “essential health benefits”; to charge higher premiums to people with preexisting conditions, and deny them coverage outright if they had failed to maintain “continuous coverage”; and set a dollar limit on the amount of benefits that consumers could draw on (which is to say, a sneak provision that renders the insurance plan useless if an enrollee happens to develop an exorbitantly expensive medical condition).The one catch was that insurers who sold such skimpy plans would be required to also sell at least one Obamacare-compliant option over the exchanges. This arrangement would allow (temporarily) healthy people to get (junky) insurance at a very cheap price – while rendering the risk pool for Obamacare-compliant plans exceptionally sickly, there by causing premiums to skyrocket for people who required comprehensive coverage.This all constituted a flagrant violation of federal law, But responsibility for enforcing said law lay with Trump’s Health and Human Services Department, which has been flagrantly violating the spirit of Obamacare for more than a year now……But on Thursday night, Trump’s Health Department (somewhat apologetically) announced that it would not allow Idaho to comport itself as a sovereign nation. In a letter to Governor Otter, Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), wrote, “CMS is committed to working with states to give them as much flexibility as permissible under the law to provide their citizens the best possible access to healthcare. However, the Affordable Care At remains the law.”……Verma encouraged Idaho to try a subtler approach to nullifying Obamacare, noting that its proposal could have passed legal muster “with certain modifications.”… April 9, 2018: Reuters posted an article titled: “Trump administration issues rule further watering down Obamacare”. From the article: The Trump administration took additional steps to weaken Obamacare on Monday, allowing U.S. states to relax the rules on what insurers must cover and giving states more power to regulate their individual insurance markets.The Centers for Medicare and Medicaid Services issued a final rule that allows states to select essential health benefits that must be covered by individual insurance plans sold under former President Barack Obama’s healthcare law. The 2010 Affordable Care Act requires coverage of 10 benefits, including maternity and newborn care and prescription drugs. Under the new rule, states can select from a much larger list which benefits insurers must cover.That could lead to less generous coverage in some states, according to Avalere Health, a research and consulting firm.President Donald Trump’s administration has used its regulatory power to undermine Obamacare after the Republican-controlled Congress last year failed to repeal and replace the law. About 20 million people have received insurance coverage through the program… April 10, 2018: Modern Healthcare posted an article titled: “5 takeaways from CMS’ final 2019 ACA marketplace rule”. It was written by Shelby Livingston. CMS stands for Centers for Medicare & Medicaid Services. From the article: The CMS allows states to determine which essential health benefits individual and small-group plans must offer, starting in 2020. States can either adopt another state’s 2017 benchmark plan; replace one or more of its benefit categories with that of another state’s; or completely build a new essential benefits package from scratch so long as the new plan is not too generous and is in line with a “typical employer plan”.Plans will still have to offer the 10 essential health benefits required by the Affordable Care Act, such as maternity care or mental health care.The CMS is upping the rate increase threshold that triggers a review by state regulators to premium hikes of at least 15% for 2019. The agency is also exempting student health insurance coverage from rate review requirements, effective July 1.HHS (Department of Health and Human Services) is allowing “a big chunk” of Obamacare customers to drop their insurance in 2018 without having to pay an individual mandate penalty. The CMS is allowing insurance exchanges to extend exemptions to the penalty based on a lack of affordable coverage available in an area.CMS will allow anyone who lived an a region with just one insurer or none at all to claim a “hardship” exemption from the penalty for as far back as 2016.Those who only have access to an insurance plan that covers abortion may also get out of the penalty if they object to abortion coverage.The individual mandate penalty was zeroed out starting in 2019. The new exemptions would affect all those still subject to penalty for 2018 if they don’t buy coverage.The CMS went ahead with its proposal to promote innovative plan designs by eliminating standardized options from the federal marketplace in 2019. This is a major win for the health insurance industry.Starting in 2019, the CMS is relaxing the rules surrounding how much of an insurer’s premium income must bet spent on medical claims and quality improvement activities, a figure known as the medical-loss ratio. Insurers covering individuals and small businesses today must spend at least 80% of their premiums on healthcare and quality improvement.In 2019, states will be able to request changes to the individual market medical-loss ratio that insurers must meet if states can demonstrate that a lower medical-loss ratio would help stabilize their markets. April 23, 2018: Kaiser Family Foundation (KFF) posted information titled: “Understanding Short-Term Limited Duration Health Insurance”. Here are some key points from that information: …Short-term health insurance policies offer lower monthly premiums compared to ACA-compliant plans because short-term policies offer less insurance protection. Medically underwritten policies can only be purchased by people when they are healthy. Individuals who buy short-term policies and then develop health conditions will lose coverage when the contract ends. Short-term policies typically do not cover essential benefits, such as prescription drugs, and often apply dollar caps and higher deductibles on coverage that are no longer allowed under ACA-compliant individual market and group health plans. As a result, people who buy short-term policies today in order to reduce their monthly premiums take a risk that, if they do need medical care, they could be left with uncovered bills and/or find themselves “uninsurable” under such plans in the future (though they would be able to buy ACA-compliant policies at the next open enrollment period).With significant attention focused recently on issues like rising drug prices, the opioid epidemic, and mental health awareness, it is notable that short-term plans generally exclude or severely limit coverage for mental health, substance abuse, and prescription drugs. As is the case with four of the 10 products offered on eHealth and/or Agile Health Insurance the cover at least some substance abuse and mental health services, an enrollee suffering from a dual diagnosis may only recovered for care received up to a maximum of $3,000. And in 15 states, no short-term plans offered on these platforms cover prescription drugs.To the extent that healthy individuals opt for cheaper short-term policies instead of ACA-compliant plans, such adverse selection contributes to instability in the reformed non-group market and raises the cost of coverage for people who have health conditions. Income-related premium subsidies in the non-group market offset the cost differential, and so help correct for adverse selection to a significant extent. Lower-income people would be protected by the premium subsidies, but middle-income people not eligible for subsidies who buy ACA-compliant plans would likely see premium increases. So far, the individual mandate penalty also has helped offset the cost differential between short-term plans and ACA-compliant plans, though this will disappear starting in 2019. The combined effect of repealing the individual mandate penalty has helped offset the cost differential between short-term plans and ACA-compliant plans, though this will disappear starting in 2019. The combined effect of repealing the individual mandate penalty and the administration’s efforts to promote the sale of short-term plans could result in fewer people signing up for ACA-compliant plans and higher premiums in the ACA-compliant individual market, potentially adversely affecting the stability of the ACA-compliant individual market…. April 30, 2018: Journal Sentinel (Part of the USA Today Network) posted an article titled: “Wisconsin unlawfully denies necessary treatment for transgender Medicaid recipients, lawsuit claims”. It was written by Bruce Vielmetti. From the article: Wisconsin unlawfully denies Medicaid coverage for necessary transgender medical treatments, two transgender residents claim in a federal lawsuit filed Monday.Their doctors say Cody Flack of Green Bay and Sara Ann Makenzie of Baraboo need additional surgery to help confirm their gender identities, but the state has turned them down for coverage, which they can’t afford on their own, citing a rule that groups the treatments with tattoo removal and earlobe repair.Though the federal Medicaid Act and state statutes say coverage should not be arbitrarily withheld based on diagnosis or condition, a Wisconsin Department of Health and Human Services regulation from 1997 cites care related to gender transition – along with tattoo removal and earlobe repair – as “medically unnecessary”……Wisconsin is one of 10 states that deny Medicaid coverage of treatments for gender transition, according to the lawsuit. Nineteen states explicitly cover, and the rest have no explicit policy either way.Ever since, bureaucrats cite the rule to deny breast removal or augmentation, genital surgeries and some hormone treatment coverage for transgender Medicaid recipients, even when admitting the procedures are effective in treating gender dysphoria, the range of conditions suffered by those who identify as a gender other than the one assigned at birth.The lawsuit, filed in federal court in Madison, contends there is no rational or legitimate basis for excluding the coverage, which denies necessary care to members of a disfavored group……The suit says Wisconsin’s coverage exclusion violates the Affordable Care Act, the Medicaid Act and the due process guarantee of the Fourteenth Amendment. It asks that the court enjoin enforcement of the regulation and award damages and costs to the plaintiffs… April 30, 2018: Politico posted an article titled: “Maine governor sued for defying Medicaid expansion ballot measure”. It was written by Rachana Pradhan. From the article: Obamacare supporters are suing Maine Gov. Paul LePage’s administration to force him to expand Medicaid, accusing the Republican of ignoring a ballot initiative that ordered the state to join the coverage program.LePage has refused to expand Medicaid nearly six months after 59 percent of the state’s voters approved it in a first-of-its-kind ballot measure. He has insisted he won’t adopt Medicaid expansion unless state lawmakers meet his conditions for funding the program.“With the goal of getting health care to people as soon as possible, we decided we couldn’t wait any longer,” said Robyn Merrill of Maine Equal Justice Partners, one of the advocacy groups behind the lawsuit.The lawsuit against LePage’s administration was expected after the Maine Legislature’s recent session ended without a funding agreement. A LePage spokesperson didn’t immediately respond to a request for comment.LePage, now in his last year in office, previously vetoed Medicaid expansion bills five times, prompting the state’s Obamacare supporters to organize the ballot initiative last year. Advocates are spearheading similar campaigns to get measures on the ballot this year in Idaho, Nebraska, and Utah……Roughly 80,000 low-income Maine adults are supposed to qualify for Medicaid benefits starting July 2, according to the ballot measure. The LePage administration skipped an early April deadline to formally notify the federal government it would expand Medicaid.The lawsuit against the Maine Department of Health and Human Services was filed in state Superior Court. Other groups bringing the lawsuit include the Maine Primary Care Association and Maine Consumers for Affordable Health Care.The office of Maine Attorney General Janet Mills, a Democrat running for governor this year, declined to comment on whether she would defend the state in the litigation… May 2018: Urban Institute posted The Healthy America Program. It was written by Linda J. Blumbert (an Institute fellow in the Health Policy Center at the Urban Institute. She is an expert on private health insurance (employer and nongroup), health care financing, and health system reform. It was also written by John Holahan (an Institute fellow in the Health Policy Center, where he previously served as center director for over 30 years. His recent work focuses on health reform, the uninsured, and health expenditure growth, and on developing proposals for health systems reform.) It was also written by Stephen Zuckerman (a senior fellow and Vice President for health policy at Urban. He has studied health economics and health policy for 30 years and is a national expert on Medicare and Medicaid payment, including how payments affect enrollee access to care and the volume of services they receive.) Here are some key points of The Healthy America Program: Since efforts to “repeal and replace” the Affordable Care Act (ACA) have failed, and bipartisan attempts to improve the law have stalled, some policymakers are now looking beyond incremental fixes. Here, we present a set of policy ideas that would provide universal access to comprehensive coverage but would allow people to keep their employer-sponsored coverage, would offer a range of insurer options and ensure broad pooling of health care risk, would not have an employer mandate, would provide income-related federal assistance, and would create a more flexible individual incentive to remain insured under the ACA.The proposal builds on components of the Medicare program and the ACA Marketplaces. However, it simplifies the current health insurance system by integrating Medicaid acute care for nonelderly people and the Children’s Health Insurance Program (CHIP) – while preserving access to their benefits – with coverage for people enrolled in private nongroup insurance and people currently uninsured.This large new Medicare-style marketplace, featuring a public plan and private insurer options, would contain costs by fostering competition among many insurers, capping provider payment rates, and addressing prescription drug pricing. This proposal is less ambitious than a single-payer system (i.e. Medicare for All), but would get close to universal coverage with much lower increases in federal spending and less disruption for people currently enrolled in employer coverage or Medicare… We propose a new program called Healthy America that would be open to all non elderly Americans. It would improve income-based assistance for premiums and cost-sharing and reduce costs in less competitive areas. Like Medicare, it would offer a public plan and private insurance plans; like Medicare Advantage, its private options would benefits from caps on provider payment rates.The Healthy America program would collect enrollees’ monthly payments of income-related premiums, and these payments would be reconciled with actual income through tax filings at the end of the year. People who decide to remain uninsured would lose a tax benefit, but they could reverse some of that loss by becoming and remaining insured in the following year.The tax-excluding for employer-sponsored insurance would stay in place, providing the financial incentive for most workers to continue obtaining coverage through their workplace. People who choose to enroll in employer-sponsored insurance would not pay income-related premiums for Healthy America.The acute care portion of Medicaid for the non elderly and CHIP would be incorporated into the Healthy America program, along with supplemental benefits (e.g., transportation; early and periodic screening, diagnostic and treatment; access to essential community providers) for low-income children and enrollees with disabilities to ensure that people eligible for Medicaid under current law would have the same benefits under the new program.States would be required to continue contributing what they currently do to Medicaid and CHIP for these populations, and future state spending amounts would be indexed to a five-year rolling average of gross domestic product (GDP) growth. Adults and children would no longer have to change insurance plans when family income changes.Nonelderly people with disabilities who are eligible for Medicare could choose between enrolling in coverage with income-related assistance through the Healthy America program or obtaining their coverage through Medicare as under current law. Nonelderly people with disabilities who are ineligible for Medicare would be edible for coverage through the Healthy America program.The Medicare program would remain unchanged for all people ages 65 and older and for eligible people with disabilities. The current Medicare cost-sharing structure, including different deductibles for Parts A, B, and D and no out-of-pocket limits, could be changed to match the Healthy America program.All Healthy American plans would cover the ACA’s essential health benefits, along with supplemental benefits for low-income children and for enrollees with disabilities. These supplements would ensure that people eligible for Medicaid under current law would have the same benefits under the new program. Here are some details on how premiums would work: Premiums for the Healthy America plans would be income related, with federal subsidies tied to the premium associated with the benchmark 80 percent AV public plan option.People with incomes below the tax-filing threshold and others with incomes below 138 percent of FPL would not be charged premiums if they enroll in a plan with premiums no higher than the benchmark plan.People with incomes between 138 and 150 percent of FPL would pay premiums ranging from 0 to 2 percent of income for the benchmark plan.People with incomes between 150 and 200 percent of FPL would pay premiums ranging from 2 to 4 percent of income for the benchmark plan.People with incomes between 200 and 250 precent of FPL would pay premiums ranging from 4 percent to 6 percent of income for the benchmark plan.People with incomes between 250 and 300 percent of FPL would pay premiums ranging from 6 to 7 percent for the benchmark plan.People win incomes between 300 and 400 percent of FPL would pay premiums ranging from 7 to 8.5% of income for the benchmark plan.People with higher incomes would pay premiums of no more than 8.5 percent of income for the benchmark plan.At all incomes, household premium contributions for the benchmark plan would never exceed the total benchmark premium for that person or family. Premiums would be subject to modified community rating rules as under ACA, with age rating limited to a ratio of 3 to 1, as in the ACA-compliant nongroup and small-group insurance markets today. Here are some additional details: The benchmark premium would be set much like it is in the Medicare program.People who remain uninsured would be responsible for paying their own medical bills and dealing directly with providers. Uninsured people and people with employer-based insurance could enroll in insurance through the Healthy America program at standard rates during the annual open enrollment period, as under the ACA.Limited special enrollment periods would also be available for circumstances such as birth, adoption, and loss of employer coverage.To limit adverse selection, uninsured people would lose a percentage of their standard deduction (or the equivalent for the itemized deduction) when they pay income taxes. The percentage of the standard deduction they would lose would increase with income, making the penalty progressive.By design, people with incomes below the tax-filing threshold would owe no penalty because they would not own premiums.People with incomes of $1 million or more would lose the entire standard deduction.Most people would need to take direct action to enroll in the Healthy America program. Higher federal investment (compared with that under ACA) in outreach and enrollment assistance during open enrollment periods and throughout the year would increase awareness and lead to higher coverage rates.To boost enrollment in Healthy America and increase the diversity of its health insurance risk pools, people receiving SNAP and TANF payments would be automatically enrolled. This population would be eligible for coverage with no premium in a Healthy America plan.Short-term and other private insurance plans that do not comply with Healthy America regulations (consistent with the ACA’s regulatory framework) would be prohibited. Prohibited types of plans include short-term, limited-duration policies, and association health care risks. May 1, 2018: The Washington Post posted an article titled: “Trump’s former health secretary: Americans will pay more because GOP weakened Obamacare”. It was written by Jeff Stein. From the article: President Trump’s former top health official on Tuesday said the Republican tax law would raise the cost of health insurance for some Americans because it repealed a core provision of the Affordable Care Act.Tom Price, Trump’s first secretary of the Department of Health and Human Services, said people buying insurance on government-run marketplaces will face higher prices because the law repealed the ACA’s individual mandate. The mandate had forced most Americans to have health coverage or face a financial penalty.“There are many, and I’m one of them, who believes that that actually will harm the pool in the exchange market, because you’ll likely have individuals who are younger and healthier not participating in that market, and consequently that drives up the cost for other folks within that market,” Price said at the World Health Care Conference in Washington……”Those effects would occur mainly because healthier people would be less likely to obtain insurance and because, especially in the nongroup market, the resulting increases in premiums would case more people to not purchase insurance, the CBO [Congressional Budget Office] said at the time. [in November of 2017]… May 4, 2018: MedPage Today posted an article titled: “ACP, ACOG Fear Return of ‘Domestic Gag Rule'”. It was written by Molly Walker. From the article: Citing “something imminent” from the Trump administration in relation to Title X funding, the American College of Physicians (ACP) and the American College of Obstetricians and Gynecologists (ACOG) reiterated their concern about any changes to these programs.While it is unclear if these changes will come in the form of an executive order or more formal rulemaking, the organizations are warning of a potential Reagan-era “domestic gag rule” that forbade providers receiving Title X funding from discussing or making referrals for abortion. The rule also mandated financial and physical separation of Title X-funded programs from activities related to abortion. It was reminded in 1993 by President Clinton.In addition to reproductive healthcare, Title X clinics also provide preventative services, such as gynecology exams, for primarily low-income individuals.Officials at ACOG and ACP, which represent more than 200,000 physicians nationwide, stressed that they haven’t seen the final action so they “don’t know yet what it’s going to do”. But they believe the current administration is planning to change eligibility requirements for providers and healthcare centers to receive Title X funding, inhibiting them from offering women the fullest range of preventative reproductive health services available. The officials characterized the anticipated regulations as “turning back the clock” on women’s healthcare.“We are deeply concerned about anticipated changes to Title X, which move away from science-based principles and erode standard of care by interfering in the patient/provider relationship,” said Hal Lawrence, MD, ACOG executive vice president and CEO. “We don’t need the government interfering in the exam room, and the government should not be interfering in what women can know and what kind of options she should be given.”He further characterized the idea of not being able to go in and discuss “something that is available” with a patient as “against the ethics of the practice of medicine.”Shari Erickson, ACP’s Vice President for governmental affairs and medical practice, described any such changes to Title X as “out of date and out of touch” and that they have the potential to impact “millions of individuals,” especially women seeking access to contraception, reproductive healthcare and preventative services.“We are strongly opposed to changes that restrict federal funding for physicians and healthcare professionals,” she added… May 8, 2017: President Trump signed a Special Message to the Congress of the United States. It said: In accordance with section 1012 of the Congressional Budget and Impoundment Control Act of 1974 (2 U.S.C. 683), I herewith report 38 rescissions of budget authority, totaling $15.4 billion.The proposed rescissions affect programs of the Departments of Agriculture, Commerce, Energy, Health and Human Services, Housing and Urban Development, Justice, Labor, State, Transportation, and the Treasury, as well as the Corporation for National and Community Service, Environmental Protection Agency, Railroad Retirement Board, the Millennium Challenge Corporation, and the United States Agency for International Development.The details of these rescissions are set forth in the enclosed letter from the Director of the Office of Management and Budget. The letter from the Director of the Office of Management and Budget is long and very detailed. Here are the parts that relate to health care: Rural Community Facilities Program Account – $2,000,000 proposed for rescission. The community facilities grants provide assistance to low income rural communities for essential community facilities such as police stations and medical clinics. The FY 2018 appropriations fully funded the program, and these balances are not needed to carry out the program in FY 2018.Children’s Health Insurance Fund – $5,149,512,000 proposed for rescission. The proposal would rescind $5.1 billion in amounts made available by the Medicare Access and CHIP Reauthorization Act of 2015 to supplement the 2017 national allotments to States, including the $3.1 billion in unobligated balances available on October 1, 2017, and $2 billion in recoveries as of May 7, 2018. The 2017 one-time appropriation was made available in addition to the annual Children’s Health Insurance Program (CHIP) appropriation to reimburse states for eligible CHIP expenses. Authority to obligate these funds to states expired on September 30, 2017, and the remaining funding is no longer needed. Enacting the rescission would have no programmatic impact. The proposed recession would have no effect on outlays.Center for Medicare and Medicaid Innovation – $800,000,000 proposed for rescission. This proposal would rescind $800 million in amounts made available under Public Law 111-148 for FYs 2011 to 2019 for the Center for Medicare and Medicaid Innovation (the Innovation Center) of which there were $3.5 billion available on October 1, 2017. The Innovation Center was created to test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid, and CHIP while preserving or enhancing quality of care. These funds are in excess of amounts needed to carry out the Innovation Center’s planned activities in FYs 2018 and 2019, and the Innovation Center will receive a new mandatory appropriation in FY 2020. Enacting the rescission would also the Innovation Center to continue its current activity, initiate new activity, and continue to pay for its administrative costs.Child Enrollment Contingency Fund – $1,865,000,000 proposed for rescission. This proposal would rescind $1.9 billion in amounts available for the Children’s Health Insurance Program Contingency Fund, of which there were $2.4 billion available as of March 23, 2018. The Contingency Fund provides payments to States that experience funding shortfalls due to higher than expected enrollment. At this time, Centers for Medicare and Medicaid Services does not expect that any State would require a Contingency Fund payment in FY 2018; therefore, this funding is not needed. Enacting this rescission would have no programmatic impact. The proposed rescission would have no effect on outlays.International Disaster Assistance – $252,000,000 proposed for rescission. This proposal would rescind $252 million in prior year balances of emergency funding appropriated in FY 2015 for the Ebola response, of which there were $470 million in emergency balances available for the Ebola respond on October 1, 2017. The Congress provided these for countries affected by, or at risk of being affected by, the Ebola virus disease outbreak in 2015. These funds remain from the initial outbreak in 2015, and are no longer needed because the Ebola response has largely concluded. Enacting the rescission would therefore not impact the Ebola response. May 8, 2017: The Congressional Budget Office posted a Cost Estimate titled: “Proposed Rescissions for the Children’s Health Insurance Program”. From the Cost Estimate: The proposals would rescind approximately $7 billion. Of this, $5.1 billion would be rescinded from the unobligated balances made available by section 301(b)(3) of Public Law 114-10, and $1.9 billion would be rescinded from amounts made available for fiscal year 2018 under the Child Enrollment Contingency Fund, section 2104(n)(2) of the Social Security Act.CBO was asked for its assessment of the proposed rescissions’ effect on federal spending and insurance coverage. Authority to distribute the funds to states made available under 301(b)(3) expired in 2017. In addition, based on information from the Centers for Medicare and Medicaid Services, CBO projects the the rescission from the Child Enrollment Contingency Fund would not affect payments to states over the 2018-2028 period. For these reasons, CBO estimates that rescinding the unobligated balances would budget authority by $7 billion, but would not affect outlays, or the number of individuals with insurance coverage. May 9, 2018: The Congressional Budget Office posted a Cost Estimate titled: “H.R. 3, Spending Cuts to Expired and Unnecessary Programs Act.” From the Cost Estimate: H.R. 3 would rescind budget authority that was proposed to be rescinded in special messages transmitted to the Congress by the President on May 8, 2018, pursuant to Title X of the Impoundment Control Act of 1974.Assuming enactment by the end of June 2018, CBO estimates that the provisions of H.R. 3 would reduce budget authority by approximately $15 billion and outlays by $1 billion over the 2018-2028 period. Further, CBO estimates that the combined budgetary effects of the President’s proposals would be the same as the contents of H.R. 3.Outlay savings would be significantly lower that the amount of budget authority reminded for two reasons. First, many of the amounts proposed for recession have remained unspent by agencies for years; CBO reviewed the historical spending patterns of the affected accounts and concluded that most of the funding would not be spend under current law. Second, the administration has indicated that these proposals are aimed at reducing funding that is no longer necessary for agencies to fulfill the purposes for which it was originally appropriated by the Congress. In a letter from the Office of Management and Budget accompanying the President’s special messages, the Administration estimates that those proposals would reduce outlays by $3 billion… May 11, 2018: The White House posted “President Donald J. Trump’s Blueprint To Lower Drug Prices”. From the Blueprint: …President Donald J. Trump’s blueprint includes new actions and proposals to drive down drug prices for all Americans. President Trump’s blueprint will seek to encourage innovation, while also promoting better price competition and addressing foreign freeloading.The Department of Health and Human Services (HHS) will:Take steps to end the gaming of regulatory and patent processes by drug makers to unfairly protect monopolies.Advance biosimilars and generics to boost price competition.Evaluate the inclusion of prices in drug makers’ ads to enhance price competition.Streamline and accelerate the approval for over-the-counter drugs.Speed access to and lower the cost of new drugs by clarifying policies for sharing information between insurers and drug makers.Avoid excessive pricing by relying more on value-based pricing by expanding outcome-based payments in Medicare and Medicaid.Work to give Part D plan sponsors more negotiation power with drug makers.Examine which Medicare Part B drugs could be negotiated for a lower price by Part D plans, and improving the design of the Part B Competitive Acquisition Program.Update Medicare’s drug-pricing dashboard to increase transparency.Prohibit Part D contracts that include “gag rules” that prevent pharmacists from informing patients when they could pay less out-of-pocket by not using insurance.Require that Part D plan members be provided with an annual statement of plan payments, out-of-pocket spending, and drug price increases.Work across the Administration to address intellectual property theft and foreign freeloading…..The U.S. Trade Representative will prioritize addressing unfair intellectual property and market access policies in our trade agreements, so that partners contribute their fair share to innovation.The Administration will publish a comparison of drug prices in the United States with those in other OECD countries, to examine freeloading… The next part provides the following information on “Budge Proposals to Lower Drug Prices”: President Trump has proposed reforms to the Medicare Part D program, including:Allowing greater flexibility in benefit design to encourage better price negotiation.Offering free generics to low-income seniors.Requiring plans to share a minimum portion of drug rebates with patients.Discouraging plans from accelerating beneficiaries into catastrophic phase of the benefit with costly brand name drugs.Protecting seniors from catastrophic costs through a new out-of-pocket maximum, while ensuring plans are incentivized to limit excessive costs.Medicaid Part B reforms proposed by the President would limit payment for price increases that are above the inflation rate and cut incentives for doctors to write high-price prescriptions.Reforms would ensure hospitals paid under Medicare Part B that provide more than one precent of their patient costs in charity care could retain a discount under the 340B program.The President has proposed actions to maximize competition and innovation, including curbing abuse of FDA safety rules an the 180-day “first-to-file” exclusivity clock… May 12, 2018: President Trump released a statement titled: “Presidential Message on National Women’s Health Week”. From the statement: This Sunday marks the beginning of National Women’s Health Week. This is an opportunity to honor the importance of women across America and renew our pledge to support their health and wellbeing.Women are integral members of our families and communities who can face unique healthcare challenges. Whether breast cancer, heart disease, or Alzheimer’s, my Administration is committed to continue addressing women’s health through advancements in medical research, rapid reviews and approvals of new safe and effective therapies, and affordable treatments and care options.The ongoing opioid crisis is of particular concern for women. On average, 115 Americans die each day from opioid-related overdoses – a faster that has contributed to the decrease in life expectancy over the past two years. The crisis has hit women particularly hard in part because they are more likely to suffer from chronic pain conditions for which opioids are often prescribed….…The Department of Health and Human Services (HHS) has developed a comprehensive strategy to combat the opioid epidemic and enhance non-addictive pain treatments by working with medical experts, policymakers, community groups, and families who have experienced the tragedy of opioid addiction. Through these partnerships, the HHS Office of Women’s Health has awarded 20 grants to public and private organizations that are on the frontlines of the opioid crisis.The Substance Abuse and Mental Health Services Administration has also published guidance for treating pregnant women and new mothers with opioid use disorder, a critical resource for the Nation’s hardworking medical professionals. It is vital for the wellbeing of our Nation that we support those who are suffering from drug addictions as well as all expecting and postpartum mothers. Similarly, the National Institutes of Health is engaging in research regarding interventions to help both the mothers and infants born to women with opioid use disorder.…Through robust tax reform, we championed a doubled Child Tax Credit to ensure parents can adequately support their children. We are also focused on expanding access to paid family leave benefits for new mothers and fathers. The new reality is that in more than 60% of the homes of American married couples with children, both parents work…. Recent research suggests that women’s labor force participation has stalled due to the lack of family-friendly policies, including paid leave….Additionally, I signed an Executive Order to expand access to sports, fitness, and nutrition, with a specific focus on helping girls from economically challenged communities live act and healthy lifestyles… May 14, 2018: 45 United States Senators sent a letter to Alex M. Azar II, Secretary of the U.S. Department of Health and Human Services. From the letter: We are writing today in support of the Title X family planning program (Title X) and to express our strong opposition to any changes to Title X that would restrict access to affordable, high-quality and lifesaving reproductive healthcare in communities across the country.Title X is the nation’s only federal program dedicated to providing family planning services to low-income and otherwise underserved individuals. Each year, roughly four million women, men, and adolescents rely on Title X-funded health centers for basic preventative health care, including cancer screenings, birth control, sexually transmitted infection (STI) screenings, pregnancy testing, and well-woman exams. Nearly two-thirds of Title X patients have incomes at or below the federal poverty level, and 43% of patients are uninsured. In 2016, nearly 4,000 Title X funded health centers performed 720,000 Pap tests, provided nearly one million women with breast exams, and administered 1.2 million HIV tests. Title X providers offer confidential, medically accurate, and evidence-based care, ensuring that patients relieve the highest standard of medical care.In addition to providing care to low-income, uninsured, and underinsured individuals, Title X yeilds critical cost savings to the American healthcare system. Every dollar invested in Title X saves more than seven dollars in Medicaid-related costs. By helping individuals obtain the preventative services they need, Title X advances the health and well-being of individuals, families, and our nation as a whole while saving taxpayer dollars in the process.In keeping with longstanding legal, ethical, and medical standards of healthcare, Title X providers offer patients medically accurate counseling on and referrals for all pregnancy options – including parenting, adoption, and abortion. The Title X program has never funded abortion services at its health centers. Health centers that receive Title X to provide family planning care may also separately provide abortions using non-federal funds.In spite of the critical role that Title X-funded health centers play in promoting the health and wellbeing of millions of people, President Trump may seek to dramatically reduce the reach of Title X by reinstating the “domestic gag rule,” which was first issued under the Reagan administration but was never fully implemented. This “gag rule” would bar patients from receiving information to support their ability to make informed decisions about their own reproductive health. This means that the millions of patients who obtain care at Title X-funded health centers annually would be denied the ability to receive complete and accurate information about their medical options, including counseling on, and referrals, for abortion. On top of the ban on counseling and referrals, the “gag rule” would impose additional requirements intended to bar providers from participating in Title X that also separately provide abortion services.Calls to reinstate these policies directly acknowledge this effort as an opportunity for President Trump to fulfill his pledge to “defund Planned Parenthood,” whose health centers remain an essential part of the family planning safety net, serving 40 percent of Title X patients. In reality, other providers of Title X-funded care would face immense challenges in attempting to absorb the patients that would lose access to care if Planned Parenthood were eliminated as a Title-X funded provider. According to recent analyses, other Title-X funded providers would have to expand their contraceptive caseloads by an average of 70 percent just to maintain access to contraceptive care at current levels.A “domestic gag rule” would have a devastating impact on the overall Title X network and the millions of individuals who rely on it for care. This move would disproportionately impact communities of color, the uninsured, and low-income individuals, and it could reverse progress made in critical areas. For example, unintended pregnancy rates in the U.S. – including those among teenagers – have been declining. We cannot threaten to reverse this progress by crippling Title X: in 2015 alone, the contraceptive services supported by Title X helped women to avoid 822,000 unintended pregnancies, which would have resulted in 387,000 unplanned births to 278,000 abortions.We strongly oppose efforts to undermine the integrity of the Title X program and harm the millions of people who rely on it for care. Federal health policy should be evidence-based and produced with the best interests of patients in mind. May 15, 2018: 169 members of the United States House of Representatives sent a letter to Alex M. Azar II, Secretary of the U.S. Department of Health & Human Services. From the letter: We would like to express our support of the Title X family planning program and our strong opposition to any plans to reinstate the “domestic gag rule,” which imposes restrictions on Title X providers and restricts access to affordable, quality, and lifesaving health care in communities across the country.As you know, Title X is the only federal grant program dedicated to providing family planning services to low-income and otherwise underserved individuals. Each year, Title X offers roughly four million women and men confidential, medically accurate, and evidence-based care. With services ranging from cancer screenings to well-woman exams, Title X providers ensure their patients receive the highest standard of medical care. As every federal dollar invested in Title X saves Medicaid more than seven dollars, this is also a program that taxpayers can – and do – believe in.In keeping with longstanding legal, ethical, and medical standards of health care, Title X providers offer patients medically accurate counseling on and referrals for all pregnancy options – including parenting, adoption and abortion. The Title X program has never funded abortion services at its health centers, and health centers that receive Title X funds to provide family planning care may also separately provide abortions using non-federal funds.In spite of the critical role that Title X plays in promoting the health and well-being of millions of people, President Trump has indicated he plans to dramatically reduce its reach by reinstating the “domestic gag rule.” This rule would prevent health care providers from receiving Title X funding if they even mention aboriton or abortion-related services to their patients. The domestic gag rule would effectively restrict the ability of patients to receive medical counseling on abortion and make informed decisions about their own reproductive health. On top of the ban on counseling and referrals, the ‘gag rule’ would impose additional requirements intended to bar providers from participating in Title X that also separately provide abortion services. This would have a devastating effect on the millions of Americans who rely on Title X for basic health needs, and it would have a disproportionate impact on low-income individuals and communities of color.Reinstating the domestic gag rule is nothing more than an opportunity for President Trump to fulfill his pledge to “defund Planned Parenthood,” whose health centers serve 40 percent of Title X patients and remain an essential part of the family planning safety net. Additionally, other providers of Title X-funded care would face immense challenges in attempting to absorb the patients that would lose access to care through Planned Parenthood.Finally, a “domestic gag rule” could revers progress made in critical areas. Primarily, unintended pregnancy rates in the U.S. – including those among teenagers – have been declining. In 2015 alone, the contraceptive services supported by Title X helped women avoid 822,000 unintended pregnancies, which would have resulted in 387,000 unplanned births and 278,000 abortions. Cutting access to eligible providers would only pare back access to contraceptive services.We strongly support efforts to undermine the integrity of the Title X program and harm the millions of people who rely on it for care. Federal health policy should be evidence-based and produced with the best interests of patients in mind. It should not be the result of the political whims of a partisan campaign pledge. May 16, 2018: The Hill posted an article titled: “Graham working on new ObamaCare repeal bill”. It was written by Peter Sullivan. From the article: Sen. Lindsey Graham (R-S.C.) said Wednesday he is working on a new version of his ObamaCare repeal-and-replace bill and has not given up on efforts to do away with the law despite Republicans’ failure last year……The effort appears to have little, if any, chance of passing this year. Republican leadership has made clear that it has moved on from the ObamaCare repeal effort, and the GOP has an even slimmer margin in the Senate than they did last year when they failed to win enough votes for a bill.The new bill would keep the core element of last year’s bill from Graham and Sen. Bill Cassidy (R-La.), which is repealing ObamaCare’s subsides and Medicaid expansion and giving that money to the states in a block grant……Graham said Wednesday that he has been talking to other senators about his effort. “We’re talking to everybody,” he said.Graham’s effort is working in parallel with an effort from conservative groups like the Heritage Foundation and the Galen Institute, which are working with former Sen. Rick Santorum (R-Pa.) and other groups on a new ObamaCare replacement plan.The White House told The Hill earlier this month that it “fully supports” the effort, and White House staff have been attending meetings on the plan at the Heritage Foundation… May 16, 2018: The Hill posted an article titled: “Trump expected to cut Planned Parenthood funding through regs”. It was written by Jessie Hellmann. From the article: The Trump administration may take action to cut federal funding to Planned Parenthood as a result of pressure from congressional Republicans and anti-abortion lobbyists.Opponents of abortion have launched an all-out campaign urging the administration to bring back Reagan-era abortion restrictions on federal family planning dollars that would target Planned Parenthood.The regulations would ban organizations that receive family planning dollars under the Title X Family Planning Program, which funds organizations providing services like birth control to low-income women and men, from promoting abortion or referring patients for abortions. Former President Reagan first issues the regulations, which Democrats describe as a “domestic gag rule”, in 1988. They also require a physical separation of Title X funding recipients from abortion providers.Republicans see the action as a way to movie the GOP base ahead of the midterm elections, where the party’s majorities in the House and Senate are in play……Due to a lengthy legal battle, the regulations were never fully implemented but were upheld by the Supreme Court after Reagan left office.But with a Republican president who has promised to defund Planned Parenthood, now is the perfect time to restore the regulations, abortion opponents say……While federal law prohibits the use of federal funding for abortions in most cases, abortion opponents and Republicans have long argued money that goes to Planned Parenthood still indirectly supports the procedure.Anti-abortion advocates have been frustrated over the GOP Congress’s failure to defund Planned Parenthood. The GOP’s slim majority in the Senate has been the obstacle.Frustration swelled when Congress passed a spending bill earlier this year that excluded a measure defunding Planned Parenthood, a result negotiated between Democrats and Republicans to avoid a government shutdown… May 16, 2018: Pacific Standard posted an article titled: “Transparency Advocates Log the Disappearance of Obamacare Information from Government Websites.” The article was written by Francie Diep. From the article: Though the Affordable Care Act remains in effect, various mentions of it have disappeared from .gov webpages.The only webpage on Medicare.gov that was dedicated to describing how the Affordable Care Act affects Medicare was quietly taken down last year, a government transparency group has found.Before December of 2017, visitors to Medicare.gov could navigate to a page called “The Affordable Care Act & Medicare” from the website’s “About Us” section. The page told Medicare enrollees whether the passage of the Affordable Care Act – commonly known as Obamacare – meant the had to sign up for new plans. (It didn’t.) The page also emphasized that the law now meant Medicare covered more disease-prevention services and brand-name prescription drugs than before. Transparency advocates worry that the page’s unexplained disappearance, after months of hot debate over Obamacare’s fate, could be confusing for Medicare users, leaving them wondering if their status has changed.“Doing things quietly can oftentimes be more confusing than having a notice or having some kind of communication about why things are changing,” says Toly Rinberg, who tracks changes to .gov websites for the non-profit Sunlight Foundation. Rinberg and a team of colleagues discovered the change to Medicare.gov……Journalists and researchers have documented various mentions of the ACA disappearing from .gov websites. An ACA link was removed from the Department of Health and Human Services’ homepage within hours of President Donald Trump’s inauguration, The New York Times reports. Later, summaries of the law and positive user testimonies were taken down.Rinberg says he and his colleagues, who are automatically tracking changes to about 25,000 .gov webpages having to do with health care and immigration, have seen removals of Obamacare information from numerous websites, including that of the Department of Health and Human Service, offices within the department, and other health agencies. The Sunlight Foundation plans to publish a detailed report about those changes in about a month… May 17, 2018: Benefits Pro posted an article titled: “Obamacare startup Oscar plans expansion to new states”. It was written by Zachary Tracer. From the article: Oscar Insurance Corp., the Obamacare-focused health insurance startup, plans to expand to Arizona and at least three other new markets next year, a bet on the health law’s survival despite the turbulent politics surrounding it.In an interview, Chief Executive Officer Mario Schlosser said Oscar is meeting its goals to increase membership and revenue while gaining a better handle on medical costs……Oscar has stuck with Obamacare even after years of financial losses, as well as political uncertainty driven by the Trump administration’s push to repeal the law. After pulling back from several states for 2017, the company expanded to four markets for 2018 – Cleveland, New Jersey, Austin and Nashville – and enrolled about 240,000 members at the end of the first quarter, but from 90,000 last year……Schlosser said the company is expanding into four new markets, though he declined to name them because the company is still working on its filings with state regulators. Oscar will enter into close partnerships with hospitals systems, he said, as it did with the Cleveland Clinic in that hospital’s home city.The hospital deals help Oscar make up for one of its main disadvantages to more-established health insurance rivals, which have already established networks of doctors, clinics and medical centers. By partnering, Oscar can offer customers access to care without having to rent a medical network – a costly proposition… May 17, 2018: The New York Times posted an article titled: “Trump Administration to Tie Health Facilities’ Funding to Abortion Restrictions”. It was written by Julie Hirschfeld Davis and Maggie Haberman. From the article: Clinics that provide abortions or refer patients to places that do would lose federal funding under a new Trump administration rule that takes direct aim at Planned Parenthood, according to three administration officials.The rule, which is said to be announced Friday, is a top priority of social conservatives and is the latest move by President Trump to impose curbs on abortion rights, in this case by withholding money from any facility or program that promotes abortion or refers patients to a caregiver that will provide one……Federal family planning laws already ban direct funding of organizations that use abortion as a family planning method. But conservative activists and lawmakers have been pressing Alex M. Azar II, the secretary of health and human services, to tighten the rules further so that abortions could not occur – or be performed by the same staff – at locations that receive Title X federal family planning money.Dawn Lagunes, the executive vice president of Planned Parenthood Federation of America, called the new proposal “outrageous” and “dangerous.”The policy, she said in a statement Thursday, is “designed to make it impossible for millions of patients to get birth control or preventative care from reproductive health care providers like Planned Parenthood. This is designed to force doctors and nurses to lie to their patients. It would have devastating consequences across this country.”……Mr. Trump has shown ambivalence about Planned Parenthood, sometimes expressing support for its health-related services other than abortion. His daughter, Ivanka Trump, a senior adviser, has urged him not to strip funding for the organization, as many Republicans have proposed, warning of the possible political repercussions.Mr. Trump is set next week to give the keynote speech at the “Champion for Life” gala held by the Susan B. Anthony List. Ms. [Marjorie] Dannenfelser [president of the Susan B. Anthony List, a group that opposes abortion rights] has called Mr. Trump “the most pro-life president of our nation’s history.”The Trump administration has pressed repeatedly to impose abortion limits. Upon taking office, Mr. Trump signed a presidential memorandum reinstitution and expanding the so-called global gag rule, which bars federal funding for organizations around the world that provide abortion counseling or referrals.Mr. Trump has also taken particular aim at Planned Parenthood, which serves 41 precent of women who receive federally funded family planning services. He signed legislation last year aimed at cutting off government money from the group and others that perform abortions……Doctors have also expressed alarm at the prospect of such changes to federal family planning rules. In a conference call this month, officials from the American College of Physicians and American College of Gynecologists said the policy would harm women’s health……Abortion rights advocates also argue that the new rules could result in women not receiving reproductive health care at all, leading to more unintended pregnancies and higher mortality rates. They note that Planned Parenthood and other groups that perform abortions are often the only federally funded health care providers in certain areas of the country, meaning that some women in those places may simply not receive medical care at all under the new policy… May 18, 2018: HuffPost posted an article titled: “Trump’s New ‘Domestic Gag Rule’ Would Strip Funds from Planned Parenthood”. It was written by Laura Bassett. From the article: The Trump administration will propose a new rule Friday that would block federal funds to any organization that provides or even shares space with an abortion provider – a domestic version of the so-called “Global Gag Rule” the president reinstated and expanded last year.The move would notably strip Title X funding from Planned Parenthood, which provides birth control, STI testing and treatment, and cancer screenings to more than one-third of the federal family planning program’s 4 million low-income patients……”This is a far-reaching attack and attempt to take away women’s basic rights and reproductive rights, period,” Dawn Laguens, executive vice president of Planned Parenthood, said in a call with reporters Friday……Anti-abortion advocates have been pushing Trump since the beginning of his term to fulfill his campaign promise to defund Planned Parenthood, especially since Republicans in Congress have repeatedly tried and failed to do so. A coalition of conservative groups sent the administration a letter on May 1 urging them to take this step……Federal law already prohibits public funds from being used to pay for abortions. Women who seek abortions at Planned Parenthood or other providers must cover the cost of the procedure themselves unless their insurance plan covers it. Trump’s proposed rule would strip funds used for birth control and STD testing from organizations like Planned Parenthood and roll back a requirement that providers who receive federal subsidies for family planning services offer women information about the full range of reproductive health options, including abortion… May 18, 2018: The White House posted a statement from the Press Secretary titled: “Statement from the Press Secretary Regarding the Proposed Title X Family Planning Program Rule from the Department of Health and Human Services.” From the statement: The Administration’s announcement today of a proposed rule on Title X family planning program fulfills President Donald J. Trump’s promise to continue to improve women’s health and ensure that Federal funds are not used to fund the abortion industry in violation of the law.The President is pleased to support the proposed rule from the Department of Health and Human Services (HHS), which would update the regulations governing the Title X family planning program. This important proposal would ensure compliance with the program’s existing statutory prohibition on funding programs in which abortion is a method of family planning. The new proposed rule would not cut funds from the Title X program. Instead, it would ensure that taxpayers do not indirectly fund abortions. Contrary to recent media reports, HHS’s proposal does not include the so-called “gag rule” on counseling about abortion that was part of the Regan Administration’s Title X rule. May 18, 2018: Reuters posted an article titled: “Obamacare tied to earlier cancer detection in young women”. It was written by Shereen Lehman. From the article: Under the Affordable Care Act (ACA) provision allowing adult children to stay on their parents’ health insurance policy until age 26, young women with gynecological cancers were diagnosed and treated sooner, researchers say.Before the law, often called Obamacare, went into effect, one in three women ages 19 to 26 years had health insurance, and today more than four in five women in this age group are insured, the study team notes in Obstetrics & Gynecology.In a comparison of young women who would have had access to insurance coverage under the law, and slightly older women who would not have had the same access, researchers found that 3.6 percent more of the younger group had their cancers diagnosed at an early stage……For their study, the researchers analyzed data from a national cancer database. They included in the analysis women aged 21 to 35 diagnosed with uterine, cervical, ovarian, vulvar or vaginal cancer during the yers 2004 to 2009, before the ACA went into effect, and 2001 to 2014, after the ACA went into effect.Among women diagnosed at ages 21 to 26, the study team identified a total of 1,912 gynecologic cancer cases before the ACA and 2,059 during the ACA, and among women diagnosed between 27 and 35, there were 9,782 cases before ACA and 10,456 cases during the ACA.In addition to the younger women being more likely to be insured and diagnosed when their cancer was at an earlier stage, women in both age groups were more likely to receive fertility-sparing cancer treatments during the ACA years, the study found……The immediate extension of insurance coverage to dependents under age 26 by the ACA in 2010 resulted in improved insurance coverage rates and earlier stage at diagnosis of uterine cancer in young women aged 21 to 25……Young women have traditionally faced discriminatory insurance practices such as higher insurance premiums than mean at the same age and denial of maternity coverage… May 29, 2018: The Hill posted an article titled: “Fourth federal judge blocks Trump’s cuts to teen pregnancy prevention.” It was written by Jessie Hellman. From the article: A fourth federal judge has ruled against the Trump administration’s decision to prematurely end grants aimed at cutting teen pregnancy rates.Judge John Coughenour in Washington state ruled Tuesday afternoon that the administration unlawfully ended grants two years early for the King County Health Department in Seattle, which participated in the Teen Pregnancy Prevention (TPP) Program.“This ruling is such a relief, as we are so close to the finish line for completing this study and building an evidence base for sex education nationwide,” said Patty Hayes, director of public health for Seattle and King County.The ruling is significant as a class-action lawsuit filed by the remaining 72 grantees plays out in court.Federal judges have now ruled in four different cases involving nine TPP grantees that the administrations actions were unlawful. The rulings mean the Department of Health and Human Services (HHS) will have to process applications for the final two years of funding……Trump appointees at HHS are pushing to give the TPP program a greater emphasis on abstinence education… May 30, 2018: The White House posted a fact sheet titled: “President Donald J. Trump to Sign Right to Try Legislation Fulfilling the Promise He Made to Expand Healthcare Options for Terminal Americans”. From the fact sheet: The bill amends Federal law to allow certain unapproved, experimental drugs to be administered to terminally ill patients who have exhausted all approved treatment options and are unable to participate in clinical drug trials.Eligible drugs must have undergone the Food and Drug Administration’s (FDA) Phase I (safety) testing.The bill requires any manufacturer or sponsor of an eligible investigational drug to report to the FDA on any use of the drug on a “Right to Try” basis.The FDA wil post an annual summary report of “Right to Try” use on its website.The bill limits the the liability of drug sponsors, manufacturers, prescribers, or dispensers that provide or decline to provide an eligible investigational drug to an eligible patient.The FDA’s “compassionate use” application is complicated and time-consuming, resulting in only 1,200 approved applications per year.With President Trump’s signature the Federal government joins with 40 states that have approved the right of terminally ill patients to try potentially life saving drugs. May 30, 2018: Donald J. Trump @realDonaldTrump tweeted: “With the #RightToTry Law I signed today, patients with life threatening illnesses will finally have access to experimental treatments that could improve or even cure their conditions. These are experimental treatments and products that have shown great promise…” May 30, 2018: The Hill posted an article titled: “Trump signs ‘right to try’ drug bill”. It was written by Jessie Hellmann. From the article: President Trump signed a bill Wednesday allowing terminally ill patients access to experimental medical treatments not yet approved by the Food and Drug Administration (FDA).Dubbed “right to try,” the law’s passage was a major priority of Trump and Vice President Pence, as well as congressional Republicans……Trump thanked lawmakers sitting in the audience who sponsored the bill, including Sen. Joe Donnelly, a vulnerable Democrat up for reelection in Indiana.Despite calling Donnelly a “really incredible swamp person” earlier this month, Trump thanked the senator for his work on the bill.Sen. Joe Manchin (W. Va.), another vulnerable Democrat up for reelection, was the only other Democratic co-sponsor on the bill, but did not attend the ceremony because he is in West Virginia this week, his office said……Most Democrats and public health groups oppose the bill, arguing that it could put patients in danger.“FDA overbite of access to experimental treatments exists for a reason – it protects patients from potential sale oil salesmen or from experimental treatments that might do more harm than good,” said Rep. Frank Pallone Jr. (D- N.J.), ranking member of the House Energy and Commerce Committee.Opponents also argue it gives “false hope” to patients, since drugmakers aren’t required to give approved medicines to patients who ask for them.Supporters say, however, it will provide new treatment opportunities for terminally ill patients who have exhausted existing options… May 30, 2018: NJ.com posted an article titled: “Phil Murphy signs law protecting Obamacare from Trump with N.J. mandate to have health insurance.” It was written by Susan K. Livio. From the article: Gov. Phil Murphy on Wednesday signed a law preserving a critical yet controversial part of the Affordable Care Act that President Donald Trump’s administration repealed last year.One of the laws creates a statewide individual mandate, which will require all New Jerseyans who don’t have health coverage through a government program like Medicare or their jobs to buy a policy, or pay a fee at tax time.The landmark federal health care Lae, better known as Obamacare, imposed the mandate to ensure younger and healthier people who might otherwise forgo insurance will buy-in and share costs… May 31, 2018: USA Today posted an article titled: “Virginia, after 5-year battle, passed Medicaid expansion for 400,000 poor people”. It was written by Doug Stanglin. From the article: After a five-year battle, the Virginia legislature has voted to expand Medicaid coverage for some 400,000 poor people, despite opposition from the White House.The Republican-controlled Senate voted Wednesday in favor of a state budget expanding Medicaid and the House of Delegates, which had previously backed the measure, gave its final approval shortly afterwards. Several Republicans in both chambers joined with Democrats to approve the measure.Democratic Gov. Ralph Northam, a pediatrician who made Medicaid expansion a centerpiece of his campaign in 2017, is expected to sign the legislation soon……The votes makes Virginia the 33rd state to approve Medicaid expansion under the Affordable Care Act, or Obamacare, according to figures compiled by the Kaiser Family Foundation……The move also reflected the state’s sharp shift to the left in the 2017 elections in which Democrats picked up 15 seats in the House of Delegates and almost took control of the body.In the final hours, Sen. Ben Chafin, a Republican lawmaker from Virginia’s economically depressed southwest coal country, announced his support for expansion on the Senate floor. He said his rural area needs expansion to bolster its hospitals and provide care for constituents.“I came to the conclusion that no just wasn’t the answer anymore,” Chafin said.Virginia GOP Speaker Kirk Cox, however, said the Trump administration’s openness to conservative reforms, including work requirements, “was probably the biggest key” in getting Republican support for the Medicaid expansion… May 31, 2018: Bloomberg posted an article titled: “Senator Behind Right-to-Try Law Says Its Intent is to Weaken FDA”. It was written by Anna Edney. From the article: Senator Ron Johnson, the chief sponsor of a new law giving terminally ill patients easier access to experimental drugs, said the aim of the measure is to weaken the U.S. Food and Drug Administration.In a letter to FDA Commissioner Scott Gottleib on Thursday, the Wisconsin Republican said the goal is to “diminish the FDA’s power over people’s lives, not increase it.”The blunt message came a day after President Trump signed the so-called right-to-try bill into law. It was in response to previous comments Gottleib had made detailing how the agency plans to implement the law.Gottleib told the news outlet Stat this month that the FDA may need to propose new regulations to ensure that patients are protected. The agency has a program to approve patient requests for access to experimental drugs if they aren’t eligible for a clinical trial. The “right-to try” law allows patients to get the unproven medications without FDA permission……The law was backed by the Goldwater Institute, a libertarian think tank, and Americans for Prosperity, which is affiliated with the conservative Koch brothers…. May 31, 2018: The Democratic Governors Association (DGA) posted a letter that they sent to Secretary of Health and Human Service (HHS), Alex Azar. From the letter: As governors representing 90 million Americans, we are deeply concerned with the Administration’s plan to undermine women’s health and place sweeping restrictions on reproductive healthcare providers across our country. For more than 40 years, Title X has been an important partnership between the federal government and states that has been supposed by Democrats and Republicans alike. This dangerous proposal would upend decades of bipartisan cooperation, taking away women’s healthcare through trusted medical providers like Planned Parenthood and eroding their access to comprehensive, medically accurate information. We strongly urge you to reconsider this plan, which is nothing more than a domestic “gag rule” that poses serious risks to women’s health.We stand with women and men in our states by rejecting this Administration’s efforts to interfere with the doctor-patient relationship, gut women’s access to family planning services, and force medical professionals to knowingly withhold information from their patients. If the federal government breaks its commitment to states in the Title X program, we will react in kind and do what is necessary to protect the health of our constituents. We call on Americans to actively and aggressively oppose this proposed action. And if this reckless policy is finalized as written, we will have no choice but to explore all possible avenues, including legal options, to block it from harming the women in our states. Our voices will be heard on this damaging proposal, and we are prepared to match our words with actions.We strongly urge you not to undermine the important work that Governors and administrations of both parties have done for decades to support women and families through Title X. We will continue to consult with our states’ Attorneys General, state legislatures, and state health agencies to stop this rule from harming the millions of women we are sworn to protect. It was signed by the following Democratic Governors: Governor Jay Inslee – WashingtonGovernor Gina Raimondo – Rhode IslandGovernor Andrew Cuomo – New YorkGovernor Mark Dayton – MinnesotaGovernor John Hickenlooper – ColoradoGovernor Dan Malloy – ConnecticutGovernor Steve Bullock – MontanaGovernor David Ige – HawaiiGovernor Tom Wolf – PennsylvaniaGovernor Kate Brown – OregonGovernor John Carney – DelawareGovernor Roy Cooper – North CarolinaGovernor Phil Murphy – New JerseyGovernor Ralph Northam – Virginia June 1, 2018: Nevada Health Link posted a blog titled: “Short Term Limited Duration Plan Impact on The Individual Market”. From the blog post: The U.S. Department of Health and Human Services (DHHS) released a final rule that will undermine high-quality, comprehensive insurance for adults, children, and especially people with pre-existing conditions. The final rule on short-term limited duration plans (STLD) loosens requirements on insurance plans that can discriminate against people with pre-existing conditions, don’t have to cover essential benefits, don’t cover prescription drugs outside of the hospital setting, and otherwise, leave people unprotected from health and financial harms. Nevada Revised Statutes limit STLD plans 185 days… Nevada Health Link provided a list of benefits that are NOT covered by Short-Term Limited Duration health plans: Maternity health carePrescription drug coverageMental health careSubstance use disorder servicesPreventative care – annual exams, check-ups, cancer screeningsTreatment for developmental delays Nevada Health Link also provided information, in the form of a graphic, that shows other problems with Short-Term Limited Duration health plans: Can decline coverage for pre-existing conditionsCan charge more for pre-existing conditionsCannot apply financial subsidy assistance toward monthly costNot required by law to cover doctor visitsNot required by law to cover ER visitsNot required by law to cover prescription drugsNot required by law to cover laboratory workNot required by law to cover pediatric servicesNot required by law to cover physical therapyNot required by law to cover preventative and wellness servicesNot required by law to cover maternity careNot required by law to cover mental health and addiction servicesCan place limitations on yearly or lifetime insurance coverageHave no limits on out-of-pocket expensesDo not have to clearly explain benefits to consumers June 1, 2018: Fortune posted an article titled: “Virginia Will Expand Medicaid Under Obamacare. That’s a Huge Deal for 400,000 People.” It was written by Sy Mukherjee. From the article: A raging political battle over Obamacare came to an abrupt end Wednesday when the Virginia legislature – controlled by Republicans – voted to expand Medicaid under the health law. Newly elected Democratic Governor Ralph Northam is expected to sign the legislation, which is projected to extend health coverage to some 400,000 low-income Virginia residents……While Congress did nix Obamacare’s individual mandate to carry health insurance as part of the tax law signed by President Trump late last year, most of its major provisions – including the popular Medicaid expansion aimed at households earning just 138% of the Federal Poverty Level (or about $35,000 for a family of four) – remain in effect… June 1, 2018: Des Moines Register posted an article titled: “Sen. Chuck Grassley: ‘We’ve got to give up’ on repealing, replacing Obamacare”. It was written by Luke Nozicka. From the article: Republican Sen. Chuck Grassley this week told people gathered at an Iowa town hall that politicians should “give up” on repealing and replacing the Affordable Care Act.During the meeting Thursday in Orange City, Grassley started answering a question about bipartisan efforts to improve the legislation before saying, “Oh, by the way, we’ve got to give up on repeal and replace.” A video of his answer was posted online by American Bridge 21st Century, a Democratic organization.In an email, Grassley’s press secretary, Nicole Teiman, said the senator was speaking to a “mathematical reality: the votes to repeal and replace Obamacare aren’t there in the current Congress, an assessment he and other senators have expressed before.”……A majority of Iowans, 58 percent. said they mostly oppose the direction congressional Republicans were heading in as they crafted health care legislation, the Des Moines Register/Mediacom Iowa Poll found in July 2017. Most of those opponents, 61 percent, said the GOP’s proposed changes go to far, while 31 percent said they do not go far enough. June 2, 2018: The Hill posted an article titled: “States defy Trump on ObamaCare”. It was written by Nathaniel Weixel. From the article: …Several states, including California and Maryland, are looking to put limits on short-term insurance plans, even as there Trump administration is poised to expand access to them nationwide.The states are doing so because they fear the availability of the short-term plans will drive up premium costs for ObamaCare.On another front, Vermont and New Jersey have passed laws that require people to buy health insurance. These individual mandate laws are meant to replace the now-repealed federal requirement.Advocacy groups and state officials that back these measures say states are seeking to protect advances made under ObamaCare from attacks by the Trump administration, which sought to repeal and replace the law and, failing that, tried to chip away at it……Costs are a big driver in the efforts by states.The cost of health insurance premiums on the ObamaCare exchanges is projected to jump in the coming weeks and months. Some states could see major double-digit spikes next year.The high costs are blamed on actions the administration has taken that could cut into ObamaCare’s enrollment.“There’s been a series of actions taken by the current administration that have undermined enrollment,” Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, said when he announced a potential 26 percent premium increase for next year in Maryland……Massachusetts first imposed a mandate in 2006 as part of then Gov. Mitt Romney’s (R) heart reform plan, which served as a model for ObamaCare.Vermont’s Republican Gov. Phil Scott also signed an individual mandate bill late in May, but it won’t take effect until 2020, and many of the details, including the penalty and enforcement mechanisms, still need to be decided.Maryland lawmakers discussed passing a mandate law for 2016, but ultimately only passed a commission to study it……California passed a bill that would completely prohibit the sale of short-term plans beginning in 2019, but it has yet to be signed into law.Lawmakers in Hawaii passed a bill that would essentially eliminate the state’s short-term health plan market by prohibiting their sale to anyone eligible for a plan on the ObamaCare exchange. That bill is also awaiting the governor’s signature.Maryland’s GOP Gov. Larry Hogan recently signed a bill that limits short-term plans to three month, and prohibits their renewal… June 4, 2018: Reuters posted an article titled: “U.S. black lung fund will need taxpayer bailout of coal tax fails: GAO”. It was written by Valerie Volcovici. From the article: A federal fund to help U.S. coal miners disabled by black lung disease will require a multibillion-dollar taxpayer bailout if Congress does not extend or increase the tax on coal production that funds it, according to a government report on Monday.Coal companies are currently required to pay $1.10 per ton tax on underground coal production to finance the federal Black Lung Disability Trust Fund, which pays medical and living expenses for eligible miners, but that amount is scheduled to revert to the 1977 level of 50 cents.“With the scheduled 2019 tax decrease, our moderate case simulation suggests that expected revenue will likely be insufficient to cover combined black lung benefit payments and administrative costs, as well as debt repayment expenditures,” according to a report from the non-partisan Government Accountability Office.Cases of black lung, an incurable illness caused by inhaling coal dust, are rising to levels not seen in decades as miners plumb the depths of played-out coal seams using heavy blasting equipment, according to government health officials.The fund that helps them is already roughly $6 billion in debt, as revenue since it was created in the 1970s has failed to keep up with outflows. The debt could balloon to $15 billion by 2050 without congressional action, the GAO report said.The GAO offered three options to improve the solvency of the fund: extend the current excise tax rate to reduce the debt to $4.5 billion debt by 2050, increase the tax rate by approximately 25 percent to eliminate the debt entirely by 2050, or allow the tax rate to sunset as scheduled, cancel the current debt, and appropriate $7.8 billion to the fund.The third option would amount to a multibillion-dollar transfer of liability for black lung victims from coal companies to taxpayers.The coal industry has been lobbying hard against the tax, arguing its payments have already been too high at a difficult time for mining companies and that the fund has been abused by underserving applicants, such as smokers……The United Mineworkers Union of America, the coal miners’ trade union, called on Congress to ensure that the excise tax coal companies now pay remains at current levels, especially as the incidence of disease continues to rise and affect younger miners… June 6, 2018: The New York Times posted an article titled: “Alex Azar, Health Secretary, Denies Sabotaging Insurance Markets”. It was written by Robert Pear. From the article: Alex M. Azar II, the secretary of health and human services, denied on Wednesday that Trump administration policies were driving up health insurance costs, which many experts expect to surge again in 2019.Mr. Azar, testifying before a House committee, vigorously disputed suggestions by Democrats that President Trump had sabotaged Affordable Care Act marketplaces, where millions of people obtain insurance subsidized by the federal government……The Congressional Budget Office said the full unsubsidized premium for a benchmark midlevel plan in the marketplaces rose 35 percent this year, on average, and was likely to increase about 15 percent next year. But some insurers have already requested rate increases of more than 30 percent for 2019……Insurers and consumer advocates say Mr. Trump’s efforts to undercut the Affordable Care Act have created uncertainty for insurers, causing some to withdraw from the public marketplaces……Nancy Pelosi, the House Democratic leader, cited news reports indicating that insurers around the country were using Trump administration policies to justify 2019 rate increases in Maine, Maryland, New York, Pennsylvania, Vermont, Virginia and Washington, among other states.In seeking higher rates for 2019, insurers point to several developments. Mr. Trump cut off subsidies that insurers use to reduce out-of-pocket medical costs for low-income people. And Congress, with encouragement from Mr. Trump, eliminated tax penalties for people who go without insurance, starting next year, giving healthier people less incentive to obtain coverage……Mr. Azar did announce one policy that is likely to help consumers and insurers. He said the administration would, in effect, allow insurers to continue shifting certain costs to the federal government – because officials did not have time to issue rules banning the practice in 2019.To offset the loss of federal “cost-sharing” payments, many insurers increased premiums this year. State officials in many states told them to load all the increases onto midlevel “silver plans,” because the federal government uses the cost of such plans as a benchmark in calculating premium subsidies. Those subsidies made insurance much more affordable, because they covered most or all of the premiums for many people this year.Administration officials had expressed concern about the practice and considered banning it.But Mr. Azar said, “We certainly are not able to regulate in time for the plan year” that starts in January.He also defended the administration’s decision to allow states to impose work requirements on low-income people covered by Medicaid…. June 7, 2018: The Chicago Tribune posted an article titled: “Trump administration won’t defend Affordable Care Act in case brought by GOP states”. It was written by Amy Goldstein. From the article: The Trump administration said Thursday night that it will not defend the Affordable Care Act against the latest legal challenge to its constitutionality – a dramatic break from the executive branch’s tradition of arguing to uphold existing statutes and a land mine for health insurance changes the ACA brought about.In a brief filed in a Texas federal court and an accompanying letter to House Minority Leader Nancy Pelosi, D-Calif., the Justice Department agrees in large part wit the 20 Republican-led states who brought the suit. They contend that the ACA provision requiring most Americans to carry health insurance soon will no longer be constitutional and that, as a result, consumer insurance protections under the law are not valid either.The three-page letter to Pelosi from Attorney General Jeff Sessions begins by saying that Justice adopted its position “with the approval of the President of the United States.” The letter acknowledges that the decision not to defend an existing law deviates from history but contends that it is not unprecedented.The bold swipe at the ACA, a Republican whipping post since its 2010 passage, does not immediately affect any of its provisions. But it puts the law on far more wobbly legal footing in the case, which is being heard by a GOP-appointed judge who has in recent case ruled against more minor aspects.The administration does not go so far as the Texas attorney general and his counterparts. In their suit, lodged in February in the U.S. District Court for the Northern District of Texas, they argue that the entire law is now invalid.By contrast, the Justice brief and letter say that many other aspects of the law can survive because they can be considered legally distinct from the insurance mandate and such consumer protections as a ban on charging more or refusing coverage to people with preexisting medical conditions.A group of 17 Democratic-led states that have won standing in the case also filed a brief on Thursday night arguing for the ACA’s preservation……It was an unusual filing just before 6 p.m. Thursday, when the brief was due, and three career Justice attorneys involved in the case – Joel McElvain, Eric Bekenhauer and Rebecca Kopplin – withdrew….…The new challenge comes six years after the Supreme Court’s divided ruling that the ACA is constitutional. That ruling hinged on the reasoning that, while the government “does not have the power to order people to buy health insurance,” as Chief Justice John Roberts wrote for the majority, it “does have the power to impose a tax on those without health insurance.”……The suit is being heard by Judge Reed O’Connell, who was appointed by President George W. Bush and has ruled against the ACA in other cases the past few years… June 7, 2018: The Hill posted an article titled: “Sessions explains to Congress rationale for not defending ObamaCare”. It was written by Julia Manchester. From the article: Attorney General Jeff Sessions sent a letter to House Speaker Paul Ryan (R-Wis.) on Thursday defending the Department of Justice’s (DOJ) rationale for not defending the Affordable Care Act, also known as ObamaCare.“As you know, the Executive Branch has a longstanding tradition of defending the constitutionality of duly enacted statutes if reasonable arguments can be made in their defense,” Sessions wrote.“But not every professionally responsible argument is necessarily reasonable in this context,” he continued, adding this is “a rare case where the proper course is to forgo defense” of the law……Sessions’s move marks a break for the DOJ, which typically defends federal laws when they are challenged in court… June 7, 2018: Reuters posted an article titled: “U.S. Justice Department says Obamacare individual mandate unconstitutional” From the article: The U.S. Justice Department said on Thursday that the part of Obamacare requiring individuals to have health insurance is unconstitutional, an unusual move that could lead to stripping away some of the most significant and popular parts of the law.In a brief filed in federal court in Texas, the department said a tax law signed last year by President Donald Trump that eliminate penalties for not having health insurance rendered the so-called individual mandate under Obamacare unconstitutional.The Justice Department said that it also nullifies two other major provisions of Obamacare linked to the individual mandate, including one barring insurance companies from denying coverage to people with pre-existing conditions.Attorney General Jeff Sessions, in a letter to House of Representatives Speaker Paul Ryan, said he had determined the individual mandate will be unconstitutional when the tax law becomes effective in 2019……Sessions said in his letter that the Justice Department was not arguing that the entire law does not pass constitutional muster. He said the department only refused to defend the pre-existing conditions provision as well as one forbidding insurers from charging people in the same community different rates based on gender, age, health status, or other factors… June 7, 2018: The U.S. House of Representatives passed H.R. 3 “Spending Cuts to Expired and Unnecessary Programs Act”. It is a recession bill designed allow Congress to take away appropriated funding from programs at the Departments of Agriculture, Commerce, Energy, Health and Human Services, Justice, Labor, State, Transportation, Treasury, and the Railroad Retirement Board. H.R. 3 was sponsored by Representative Kevin McCarthy (California – Republican). The health care related recessions included: $5.1 billion from Children Health Insurance Fund – The Children’s Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. The President’s proposal contains two provisions related to CHIP that would simply rescind funds that are either no longer necessary or can’t be spent because the authority to do so expired last year. Rescinding these funds will likely have no impact on the program.$1.8 billion from the Child Enrollment Contingency Fund – Under CHIP, the Contingency Fund provides payments to States that experience funding shortfalls due to higher than expected enrollment. At this time, the Centers for Medicare and Medicaid Services does not expect that any State would require a Contingency Fund payment in FY 2018; therefore, this funding is not needed. It is important to note that the proposal would not rescind all available funding, meaning sufficient funding would be available should a state eventually qualify for a payment.$800 million from the Center for Medicare and Medicaid Innovations – Created under the Affordable Care Act, the Center for Medicare & Medicaid Innovation (the Innovation Center) with CMS supports the development and testing of innovative health care payment and service delivery models. Some details from the text of H.R. 3 about how much will be rescinded from certain programs: $5,149,512,000 from the unobligated balances of the Social Security Act are rescinded$800,000,000 from the amounts made available of the Social Security Act are rescinded$1,865,000,000 of the amounts deposited in the Child Enrollment Contingency Fund for fiscal year 2018 are permanently rescinded The vote on H.R. 3 in the House of Representatives happened on June 7, 2018. The vote was 201 YEAs to 205 NAYS. This means that the bill passed the House of Representatives. Next, it would be sent to the U.S. Senate. All of the people who voted YEA were Republicans. 19 of the people who voted NAY were Republicans: Vernon Buchanan (Florida – Republican)Carlos Curbelo (Florida – Republican)Mario Díaz-Balart (Florida – Republican)Brian Fitzpatrick (Pennsylvania – Republican)Will Hurd (Texas – Republican)John Katko (New York – Republican)Mike Kelly (Pennsylvania – Republican)Leonard Lance (New Jersey – Republican)Tom MacArthur (Connecticut – Republican)Brian Mast (Florida – Republican)David McKinley (West Virginia – Republican)Ilena Ros-Lehtinen (Florida – Republican)Peter Roskam (Illinois – Republican)Keith Rothfus (Pennsylvania – Republican)Elise Stefanik (New York – Republican)Mike Turner (Ohio – Republican)Fred Upton (Michigan – Republican)Jackie Walorski (Indiana – Republican)Kevin Yoder (Kansas – Republican) 187 of the people who voted NAY were Democrats. 11 people did not vote: Joyce Beatty (Ohio – Democrat)Salud Carbajal (California – Democrat)Kristi Noem (South Dakota – Republican)Steven Palazzo (Missouri – Republican)Jared Polis (Colorado – Democrat)Terri Sewell (Alabama – Democrat)John Shimkus (Illinois – Republican)Bill Shuster (Pennsylvania – Republican)Juan Vargas (California – Democrat)Mimi Waters (California – Republican)Tim Walz (Minnesota – Democratic-Farmer-Labor Party) June 7, 2018: The Hill posted an article titled: “House passes Trump’s plan to claw back $15 billion in spending”. It was written by JulieGrace Brufke and Niv Elis. From the article: The House voted along party lines late Thursday to pass a White House proposal that would claw back nearly $15 billion in previously approved government funding.The House approved the measure in a vote of 210 – 206, with conservatives calling ti a step in the right direction after they ripped into the price tag of the $13 trillion spending bill President Trump signed earlier this year……Trump had pushed lawmakers earlier this week to vote in favor of the clawback plan, known as the Spending Cuts to Expired and Unnecessary Programs Act, which GOP leaders have been working on for two months……While the move was welcomed by fiscal hawks, Democrats and a handful of moderates argued it could hinder future budget negotiations and drain unused funds that may prove necessary for programs down the road.Opponents blasted the administration’s decisions to target unobligated funds within the Children’s Health Insurance Program (CHIP) – which make up nearly half of the $14.7 billion in rollbacks – alleging the cuts could lead to a loss of coverage that is higher than expected……The CBO analysis supported Republican arguments that the plan would not affect children’s health. Its analysis found that the recessions would not affect any spending on children’s health, and would not affect any coverage.But it also showed that the move would have little impact on spending.Because the funds in question were unobligated or associated with expired programs, canceling the budget authority to spend them would do little to affect the actual spending……Whether the Senate will move on the measure remains unclear… June 7, 2018: CNN posted an article titled: “Trump moves pushing up Obamacare premiums for 2019”. It was written by Tami Luhby. From the article: …Insurers in several states have requested large rate hikes for 2019, with many pointing to steps taken by President Donald Trump and Republicans in Congress as the main reason why.New York insurers want to hike rates by 24%, on average, while carriers in Washington are looking for a 19% average premium increase. In Maryland, CareFirst is asking for an average 18.5% rate bump for its HMO plans and a 91% spike for its PPO policies (which have far fewer enrollees), while Kaiser Permanente wants to boost premiums by more than 37% on average.Many insurers cite two key drivers of the increases: Congress’ elimination of the penalty for the individual mandate — which requires nearly all Americans to have coverage or pay up — and the Trump administration’s expected expansion of two types of health plans that don’t have to adhere to Obamacare’s regulations……Jettisoning the individual mandate penalty is expected to cause premiums to rise by about 10%, the industry group said, citing reports by the Congressional Budge Office and independent actuaries. That’s because younger and healthier people will be more likely to forgo insurance since they will no longer have to pay a penalty. Insurers fear they will be left with sicker and older policyholders, prompting them to request higher rates to cover the anticipated increase in claims.Also, Trump last year issued an executive order directing federal agencies to make it easier to buy two alternates to Affordable Care Act plans. One would allow small business to band together to buy coverage through association health plans, while the other would let Americans buy short-term coverage that would last less than a year, rather than the current 90-day limit. Both of the types of policies are expected to have lower premiums, but would cover fewer benefits — making them more attractive to healthier Americans who don’t need comprehensive coverage.Insurers in remaining states will file proposed rates in coming weeks. Regulators will review the requests and could change them significantly. Premiums will be finalized in September and open enrollment starts November 1……Also, most Obamacare enrollees won’t have to pay more for coverage next year, regardless of how much insurers hike premiums. That’s because they receive federal subsidies that limit their rates to less than 10% of their income.However, the rate hikes will hit the millions of Americans who earn too much for subsidies or who buy individual coverage outside of the Obamacare exchanges. June 8, 2018: The American Psychiatric Association posted a news release titled: “APA Calls on Administration to Defend Patient Progections in Affordable Care Act”. From the news release: In response to the recent decision by the Department of Justice not to defend the constitutionality of the patient protections provided in the Affordable Care Act in the federal lawsuit Texas v. United States, the American Psychiatric Association (APA) issued the following statement:“We strongly condemn the Administration’s decision not to defend the patient protections provided in the Affordable Care Act, an established law of the land,” said APA President Altha Stewart, M.D. “In particular, this decision could lead to insurers denying coverage to the 130 million Americans with pre-exsiting conditions. This is harmful to the health of these Americans and is very short-sighted considering the nation is in the midst of an opioid epidemic and 30% rise in suicide rates. We call upon the Administration to reverse this decision and defend the rights of our patients.” June 8, 2018: NBC News posted an article title: “Sessions takes aim at heart of Obamacare – coverage for pre-existing conditions”. It was written by Andrew Harnik. From the article: The Trump administration said in a court filing late Thursday that it will no longer defend key parts of the Affordable Care Act, including the requirements that people have health insurance and provisions that guarantee access to health insurance regardless of any medical conditions.The decision, announced in a court filing in Texas, is a rare departure from the Justice Department’s practice of defending federal laws in court. Texas and other Republican-led states are suing to strike down the entire law because congress recently repealed a provision that people without health insurance must pay a fine. The repeal takes effect next year.Texas says that without the fine in place the requirement to have health insurance is unconstitutional and that the entire law should be struck down as a result.The administration said it agrees with Texas that the so-called individual mandate will be unconstitutional without the fine. It also said that provisions shielding people with medical conditions from being denied coverage or charged higher premiums and limiting how much insurer can charge older Americans should fall as well.But it said the rest of the law, including Medicaid expansion, can remain in place.In many ways, the lawsuit, filed in February, is a replay of the politically divided litigation that ended with the Supreme Court upholding the health care overhaul in 2012. In the new suit, California is leading a group of Democrat-led states in defending the law.The major difference is that the Justice Department under President Donald Trump has largely switched sides.Attorney General Jeff Sessions said in a letter to Congress on Thursday that Trump, who campaigned on repealing the law and nearly did so in his first year in office, approved the legal strategy……Shortly before the government’s court filing, three career lawyers at the Justice Department withdrew from the case and were replaced by two political appointees, according to court filings.Timothy Jost, law professor emeritus at Washington and Lee University in Virginia said the Trump administration is trying to persuade the court to do what it was unable to achieve in Congress last year – essential, repeal key parts of the Obama health law.Jost said its telling that three career Justice Department lawyers refused to support the administration’s position….…Despite the Justice Department position, the Health and Human Services Department has continued to apply the health law. Indeed, sign-up season for 2018 under the Trump administration resulted in only a slight enrollment drop-off from Obama’s last year.Insurers are now finalizing their premium requests for 2019, and Jost said the Justice Department filing may prompt jittery carriers to seek higher rates… June 8, 2018: President Trump issued a statement titled: “Presidential Message on Men’s Health Week”. From the statement: Men’s Health Week is an opportunity to raise awareness of the diseases and illness that are most prevalent among American men and to reiterate the importance of early detection and preventative health practices. During this week, I encourage all men to evaluate both their mental and physical health hand to focus on living a healthy lifestyle.While there are many factors that contribute to a healthy life- including diet, exercise, stress management, and mental and emotional wellness – one of the most important practices is to regularly visit the doctor and the dentist. Men are less likely than women to visit their healthcare providers, often missing out on critical treatments that can protect their overall health and wellbeing. Individuals who have routine check-ups better understand the association between a healthy lifestyle and a greater quality of life.Although Americans are living longer, healthier lives, we cannot ignore emotional and mental health, or the stigmas that prevent individuals from seeking treatment and recovery support services as part of their overall welfare. Serious mental illness, such as major depressive disorder, has robbed too many fathers, brothers, and sones, of their potential, and has contributed to rising suicide and drug overdoses. For these reasons, my fiscal year 2019 Budget request to Congress includes $10 billion in new funding to address the opioid abuse and overdose epidemic and mental health. This funding will improve access to evidence-based treatment services to support those suffering from mental disorders and substance use disorders……As we observe Men’s Health Week, we celebrate the advances we have made in improving men’s healthcare, while recognizing the importance of prioritizing both physical and mental health in men of all ages. June 8, 2018: Senator Diane Feinstein (Democrat – California) posted a press release titled: “Senate Democrats Urge Trump DOJ to Reverse Decision Not To Defend Affordable Care Act In Court”. From the press release: …The text of the Senate Democrat’s letter can be found below:Dear President Trump:We are deeply concerned that you have directed the Justice Department to no longer defend the constitutionality of the Affordable Care Act, including its vitally important protections for people with pre-existing conditions. Your decision yesterday to call protections for pre-existing conditions “unconstitutional” directly contradicts the 2012 U.S. Supreme Court decision, NFIB v. Sebelius. Disturbingly, this also represents another step in your administration’s continuous attacks on the rights of people with pre-existing health conditions and we urge you to reverse this decision.There are currently as many as 133 million non elderly Americans with a pre-existing condition – which is more than half of the people not on Medicare. Taking this position could render millions of Americans uninsurable or facing higher premiums. Prior to 2014, people with pre-existing conditions often faced higher costs or were denied coverage altogether. Under your administration, Americans have repeatedly faced the prospect of a return to the dark days in which becoming sick could mean an inability to find health insurance, women could be charged more than men, or premiums and medical costs were so high that it sent families into bankruptcy in an effort to cover the payments.During your presidential campaign, you repeatedly promised that you would retain protections for people with pre-existing conditions. Then you changed your position and supported numerous health care bills that would have gutted these protections and repealed the entire health care act. The bills would have allowed insurers to charge more or deny coverage outright based on a person’s health status, exclude critical benefits, and once again impose annual or lifetime limits on the amount of care a person could receive. Despite the repeated failure of this legislation, your administration remains undeterred in its efforts to eliminate protections for patients for pre-existing conditions and is currently in the process of finalizing a rule to expand “junk insurance.” These plans are allowed to exclude critical types of health care coverage, deny care when a person gets sick, and charge more based on gender or a pre-existing condition. You recently indicated you plan to finalize this rule, despite knowing that not a single group representing patients, physicians, nurses or hospitals is supportive.Mr. President, it is time to stop the sabotage. We are a country of laws, and the law must be respected, defended, and enforced regardless of the person occupying the Oval Office. It is concerning that career Justice Department officials withdrew from the case and were replaced by political appointees as the administration abandoned its defense of the law.The American public widely supports retaining protections for pre-existing conditions. We implore you to listen to the voices of career Justice Department lawyers, as well as concerned families, patients, doctors and hospitals that want to retain these protections, and start working with Democrats to strengthen our health care system instead of trying to tear it down.Sincerely, Senator Diane FeinsteinSenator Charles E. SchumerSenator Patty MurraySenator Ron Wyden June 8, 2018: Reuters posted an article titled: “Insurer lobby group weighs in on Obamacare individual mandate case.” It was written byTamara Mathias. From the article: Removing certain provisions tied to the Affordable care Act, former U.S. President Barack Obama’s signature healthcare law, could strike out important consumer protections and potentially harm millions of Americans, a trade association that represents U.S. health insurers said on Friday.The comments from America’s Health Insurance Plans (AHIP) come a day after the U.S. Justice Department called Obamacare’s individual mandate – which requires individuals to have health insurance or pay a penalty – unconstitutional……”Zeroing out the individual mandate penalty should not result in striking important consumer protections, such as guaranteed issue and community rating rules, that help with pre-existing conditions,” AHIP said in a statement.Removing consumer friendly provisions like guaranteed issue, whereby health insurers cannot deny coverage to applicants or charge more based on health status, will result in renewed uncertainty in the market as well as push up rates for older and sicker patients, AHIP added… June 8, 2018: Politico posted an article titled: “Trump’s latest health care move squeezes Republicans”. It was written by Jennifer Haberkorn and Adam Cancryn. From the article: Republicans who have tried to repeal Obamacare for nearly a decade believe the Trump administration is reviving a politically risky battle with a court filing that could eliminate one of the most popular parts of the law: protections for people with pre-existing conditions.The administration wants a federal court to strike the protections, providing fresh fodder to Democrats who argue that the GOP cannot be trusted to protect Americans’ health insurance months ahead of a midterm election in which health care was already a top issue. It also threatens to shift attention away from the GOP’s message on tax cuts, refocusing it on an Obamacare fight most Republicans wanted to put behind them.The administration late Thursday asked a U.S. District Court in Texas to do something congressional Republicans weren’t willing take on themselves during last year’s repeal effort: Strike the most popular part of Obamacare.Few congressional Republicans rushed to defend the administration’s move Friday, instead emphasizing their support for preserving pre-existing condition protections….…Sen. Susan Collins of Maine – one of three GOP senators who blocked the Obamacare repeal effort last year – also pushed back, warning the administration’s new bid “exacerbates our current challenges” and could undermine key patient protections.Other lawmakers points to past support for policies to prevent insurance companies from denying or dropping people with pre-existing conditions……Senate Democrats, who this week promised to force votes on health care during August, said the court filing proves their warnings that Republicans remain intent on repealing Obamacare through any means available……Within hours of the news, Democrats pounced on the Senate Republicans up for reelection this fall. The Democratic Senatorial Campaign Committee blasted releases questioning whether those Republicans – such as North Dakota hopeful Rep. Kevin Cramer – back the Trump administration’s decision……During last year’s repeal debate, Republicans decided to leave pre-existing conditions protections in place after they repeatedly became the subject of sometimes fiery town hall meetings with constituents……It is unclear how soon the U.S. District Court judge may respond to the administration’s request. If the courts strike the provision, the ruling would all but certainly be appealed – likely by a group of Democratic-led states that have weighed in on the case in courts……Insurance companies have already requested double-digit premium increases for 2019 in several states. The industry has blamed Trump administration decisions to undermine the health law, such as cutting off a key subsidy program to help low-income people pay their out-of-pocket health expenses… June 8, 2018: HuffPost posted an article titled: “Democrats Say They Have Proof Health Care Can Turn Trump Voters Against Republicans”. It was written by Kevin Robillard. From the article: …Clarity Campaigns, a Democratic polling firm, conducted the surveys in Maine’s 2nd Congressional District, a sprawling, heavily forested rural district that includes almost the entire state outside of Portland and its suburbs. The district, represented by Republican Congressman Bruce Poliquin, flipped back from backing Barack Obama by a 9-pont margin in 2012 to supporting Trump’s by 10 percentage points in 2016.Two Democratic groups, Not One Penny and Protect Our Care, paid for the polls. They have spent the past 10 months on a sustained campaign against Poliquin in the Bangor media market, which includes half the district, and their polling shows real damage.In a memo provided to HuffPost, Clarity Campaigns said the more voters fond out about Poliquin’s votes to repeal the Affordable Care Act and to support the GOP tax bill, the less they liked him. At the beginning of the campaign, 28 percent of voters in the media market approved of Poliquin and 38 percent disapproved. By the end, his numbers were significantly weaker: Just 25 percent approved, and 45 percent disapproved……The experiment reinforces the major Democratic strategy for winning back House districts where voters flipped from Obama to Trump: Focus relentlessly on unpopular GOP policies on taxes and health care, not directly on Trump’s behavior or the Russia investigation. Democrats need to win 24 seats to take back control of the House in November… June 9, 2018: Brian Schatz (U.S. Senator from Hawaii – Democrat) posted a tweet on his verified Twitter account. It said: “Whatever your political party of your views on the size of government or social issues or foreign policy or Rosanne or the NFL, if you are one of the 52 million Americans with a pre-existing health condition, I encourage you to vote for Democrats this year to save your healthcare.” June 9, 2018: The American Academy of Family Physicians, American Academy of Pediatricians, American College of Obstetricians and Gynecologists, American College of Physicians, American Osteopathic Association, and American Psychiatric Association wrote a Joint Statement on Texas v United States. From the Joint Statement: Our organizations, which represent a combined membership of more than 560,000 physician and medical student members are concerned about the Department of Justice’s decision to not defend the constitutionality of existing laws that extend patient protections to individuals in insurance markets as part of Texas v Unite States. The elimination of these protections could result in millions of people facing limited access to health care coverage and higher cost as a result of insurers being allowed to return to discriminatory coverage and pricing practices.Our organizations disagree with the Department of Justice’s decision not to defend the protections established by the Affordable Care Act that prohibit insurance companies from denying or discontinuing coverage for individuals with pre-existing conditions or other factors such as gender or race.As physicians who provide a majority of care to individuals for physical and mental conditions, we can speak clearly that these insurance reforms and protections are essential to ensuring that the more than 130 million Americans, especially the more than 31 million individuals between the ages of 55 an 64 who have at least one pre-existing condition are able to secure affordable health care coverage.We strongly urge the Department of Justice to consider its decision in Texas v United States and that we all seek policy solutions that increase access to affordable health care that provides all individuals, regardless of their gender, race, and health status, reasonable protections against discrimination in coverage and pricing. June 10, 2018: Bloomberg posted an article titled: “Health Warning: Obamacare Is in Legal Peril Once Again”. It was written by Noah Feldman. From the article: …Just in case you haven’t thought about the individual mandate and the Constitution in the last six years, let me provide an update and a brief refresher. The update is that, in 2017, Congress passed the Tax Cuts and Jobs Act. In the law, Congress repealed the tax penalty associated with the individual mandate that everyone have health insurance.In other words, the ACA still says you have to have insurance. But if you don’t, nothing happens to you……Now comes the new constitutional challenge to the ACA, filed by a group of states led by Texas. Their argument begins with the fact that, when the Supreme Court upheld the individual mandate, it did so in a very strange way. The five conservative justices all agreed that, under the commerce clause of the Constitution, Congress did not have the authority to make people buy insurance.Their reasoning was borrowed from Prof. Barnett, who had proposed in his article that while the Congress has the power to regulate existing commercial activities, it can’t force people to undertake a commercial activity they are not already engaged in. This was the famous broccoli hypothetical: the conservatives argued that the commerce clause wouldn’t allow Congress to pass a law requiring everyone to buy and eat broccoli, even though Congress could lawfully regulate broccoli prices.Despite this conclusion about the commerce clause, however, Chief Justice John Roberts joined the four liberals to uphold the individual mandate on the ground that it was a tax, and therefore fell within Congress’s separate taxing power. The other four conservatives were clearly frustrated with Roberts, but his vote carried the day.The states are now arguing that once Congress repealed the tax penalty for the individual mandate in the 2017 law, no more constitutional authority exists for Congress to keep the individual mandate in place. The commerce clause is already excluded by the Supreme Court, and now the tax rationale is gone. Trump’s Department of Justice has agreed with this claim.The states say that without the individual mandate, the whole ACA should be struck down as unconstitutional. Trump’s Justice Department didn’t go quite that far. But it did say the the ACA provisions on pre-existing conditions are so linked to the individual mandate that it should now be struck down….…But it is entirely possible that five justices would follow the chain of formal logic laid out by the states and adopted by the Justice Department. The best argument in favor of that position is that the Obama Department of Justice told the Supreme Court years back that these provisions were interlinked – “irreversible” in legal jargon.There is therefore a real and indeed significant chance that the most popular parts of the ACA could be struck down… June 11, 2018: Bloomberg posted a very detailed article titled: “Air Ambulances Are Flying More Patients Than Ever, and Leaving Massive Bills Behind”. It was written by John Tozzi. From the article: …Favorable treatment under federal law means air-ambulance companies, unlike their counterparts on the ground, have few restrictions on what they can charge for their services. Through a quirk of the 1978 Airline Deregulation Act, air-ambulance operators are considered air-carriers – similar to Delta Air Lines or American Airlines – and states have no power to put in place their own curbs.Prices for emergency medical flights have increased dramatically, as air ambulance operators expanded their networks and responded to a wider set of emergencies, including traumas, strokes, and heart attacks.The medical charge to Medicare for a medical helicopter flight more than doubled to almost $30,000 in 2014, from $14,000 in 2010, according to a report last year by the U.S. Government Accountability Office. Air Methods’ average charge ballooned from $13,000 in 2007 to $49,00 in 2016, the GAO said. Medicare, the federal health program for people 65 and older, pays only a fraction of billed charge; Medicaid, the state-federal program for the poor, pays even less……Seth Myers, president of Air Evac, said that his company loses money on patients covered by Medicaid and Medicare, as well as those with no insurance. That’s about 75 percent of the people it flies.“I fly people based on need, when a physician calls or when an ambulance calls,” He said. “We don’t know for days whether a person has the ability to pay.”According to a 2017 report commissioned by the Association of Air Medical Services, an industry trade group, the typical cost per flight was $10,199 in 2015, and Medicare paid only 59 percent that. Air-medical operators back U.S. legislation proposed by Senator Dean Heller of Nevada and Representative Jackie Walorski of Indiana, both Republicans, that would boost reimbursements by as much as 20 percent over three years. The bill would also have Medicare collect cost data from air-ambulance companies and use it to update rates to reflect “the actual costs of providing air ambulance services.” Both versions have co-sponsors from both parties.For people with private insurance, short flights in an air ambulance are often followed by long battles over the bill……The industry says insurers put patients in the middle. “We need to hold the insurers’ feet to the fire to say we need a reasonable rate,” said Myers, the Air Evac executive. He said health plans often won’t agree to network contracts that could lower costs. He declined to say how large in-network discounts are, citing nondisclosure agreements.Consumer groups and insurers counter that air-ambulance companies strategically stay out of health-plan networks to maximize revenue……Montana Senator John Tester, a Democrat, has introduced legislation that would rollback the special status of air-ambulance companies. A Federal Aviation Administration reauthorization bill passed by the House in April would make medical services provided by air ambulances subject to state regulation… June 12, 2018: Axios posted at blog titled: “Private equity’s thirst for health care providers”. It was written by Bob Herman. From the article: KKR’s $10 billion deal to take Envision Healthcare private, along with Bloomberg’s deep dive on the billing tactics of air ambulances, exemplifies private equity firms’ appetite for buying health care providers that weird a lot of market power.The big picture: These companies are a leading source of surprise medical bills, which infuriate patients but are profitable for private equity owners. Emergency rooms and ambulances aren’t real marketplaces – consumers can’t stop and shop for the best price in the middle of an emergency.The bottom line: Physician groups, emergency room staffing, and air and ground ambulances can (and in most cases do) make a lot of money because people will use their services regardless of the price……Physicians and ambulances can opt out of an insurance company’s network, unbeknown to a patient, if they feel they aren’t getting paid enough – and patients are saddled with the remaining costs……Physician and ambulance groups contend they need to bill commercial insurance more to make up for shortfalls in Medicare and Medicaid, but the cost-shifting theory often falls flat……The big question for the latest KKR deal: Will Envision stay transparent about its efforts to reduce surprise medical bills? Going private means health care groups don’t have to disclose a whole lot about their finances or strategy… June 12, 2018: Politico posted an article titled: “McConnell: ‘Everybody’ in Senate likes pre-existing condition safeguards”. It was written by Jennifer Haberkorn. Senate Majority Leader Mitch McConnell said “everybody” in the Senate wants to preserve consumer protections for people with pre-existing conditions, an Obamacare provision that the Trump administration last week said is unconstitutional and should be struck down.“Everybody I know in the Senate – everybody – is in favor of maintaining coverage for pre-existing conditions,” McConnell told reporters in the Capitol. “There is no difference in opinion about that whatsoever.”Obamacare’s prohibition on insurance companies canceling or denying coverage for people with pre-existing conditions is among the most popular provisions of the 2010 law. Congressional Republicans opted to preserve the idea of having a requirement last year even as they laid plans to repeal the law. Several GOP health plans last year would have barred insurance companies from denying coverage over pre-existing conditions but would have done so by requiring people to maintain continuous coverage or face higher costs or a waiting period. Critics said those requirements wouldn’t be as strong as the one in the Affordable Care Act.The Trump administration surprised its congressional allies last week when it asked a U.S. district court in Texas to strike the provision, along with the law’s individual mandate and Obamacare’s requirement that people cannot be charged substantially more than other people in the same age range and geographic area. Democrats immediately pounced on the Justice Department move, warning they would make it a prominent issue in the midterm election……McConnell also touted forthcoming regulations the administration could issue as soon as this week expanding association health plans, which he said could bring down premium costs. June 12, 2018: The Hill posted an article titled: “Warren presses health chief over Trump’s promise of drug price cuts.” It was written by Peter Sullivan. From the article: Sen. Elizabeth Warren (D-Mass.) pressed Health and Human Services (HHS) Secretary Alex Azar on Tuesday about why no drug companies have announced price decreases despite President Trump saying they would.Warren focused on Trump’s statement at the end of May that “in two weeks” drug companies would “announce voluntary massive drops in prices.” The two-week mark from that statement is this Wednesday.“He said there would be massive decreases in drug prices within two weeks,” Warren said during a Senate Health Committee hearing. “It’s been two weeks and there have been no decreases and an indication of increase.” Azar counters at the hearing that there are drug companies working on price decreases……The health chief said the holdup is that negotiators known as pharmacy benefit managers (PBMs) are actually discouraging price decreases because that could reduce the amount of rebates that the PBMs get……Warren, a liberal champion who is a possible 2020 presidential contender, did not buy that argument, saying, “In the words, the president’s promise that we would see massive decreases in two weeks hasn’t happened and you don’t have anyone lined up who’s actually going to decrease drug prices.”… June 13, 2018: The American Academy of Actuaries released an Issue Brief titled: “Drivers of 2019 Health Insurance Premium Changes”. From the Issue Brief Summary: Key drivers of 2019 premium changes include: Medical trend, which is the underlying growth in health care costs;Recent legislative and regulatory changes, including the elimination of the individual mandate penalty, the pending expanded availability of short-term limited duration health plans and association health plans, and whether changes made regarding how insurers are instructed to load premiums to account for cost-sharing reduction subsidies;Changes in the risk pool composition and insurer assumptions from 2018; andAny state actions to implement reinsurance programs, impose individual mandate penalties, or enact rules that would facilitate or prohibit the availability of alternative coverage options. Average premium rate changes may not represent the rate change experience by a particular consumer. A number of factors can result in a consumer’s premium differing from the average rate change, including changes in plan selection, age/family status, tobacco status, geography, or subsidy eligibility. From the Issue Brief section titled: “Premium Changes From a Consumer Perspective”: The following situations could result in a consumer’s premium change differing from the average premium change reflected in a premium rate filing. Changes in Plan Selection: As insurers enter or exit marketplaces or otherwise change their plan offerings, consumers could have different choices of insurers or plans. If particular plans are discontinued, consumers may be re-enrolled in a different plan. Even if their current plan continues to be available, consumer may choose to enroll in a different plan. Either of these scenarios could lead to a consumer’s premium change that differs from the state’s or insurer’s average premium change.Changes in Age/Family Status: Most individual consumer will experience a premium increase each year, due to aging one year.The ACA allows premiums to vary by family size. Family premiums reflect the premiums for each covered adult plus the premiums for each of the three oldest covered children younger than 21. Therefore, consumers with family coverage who experience a change in family composition could face a premium change.Tobacco Status: In most states, insurers are allowed to charge smokers more than nonsmokers, and this surcharge can vary by state and by age. For instance, older smokers can face higher surcharges than younger smokers. In plans that vary the surcharge by age, consumers who smoke will see a premium change due to the change in the tobacco use surcharge. In addition, consumers who have either started or stopped using tobacco products could see a premium change. Finally, carrier care allowed to change their tobacco rating factors with sufficient justification.Geographic Area Factors: All states require all insurers within the state to use identical rating areas approved by the Centers for Medicare and Medicaid Services. Insurers are not allowed to change the rating areas, but they are allowed to change how premiums vary across areas due to differences in networks, relative provider charge levels, and levels of medical management.While the overall impact of area factor modifications will be included in the average aggregate premium change, reported in the rate filing each insurer submits, the actual change a specific consumer experiences may vary significantly depending on where he or she lives.In addition, a consumer moving from one rating area to another may experience a premium change due to the differences in area factors.Subsidy Eligibility: The ACA provides premium subsidies in the individual market based on household income and the premium for the second-lowest silver plan. Changes in income alone can result in upward or downward changes in the net premiums that any specific consumer may have pay, even if there is no change in the underlying premiums. And even if there is no change in income, premium subsidies can increase if premiums increase. Changes in how states load premiums to cover cost-sharing reductions (CSRs) can also affect premium subsidies.Insurers are required to notify subsidized enrollees of premium changes before open enrollment. However, the notification is based on the current year subsidy and will not reflect subsidy changes due to any premium changes, including how premiums are loaded to account for CSR’s.Individuals may not be aware of the impact of the subsidy changes unless this process is changed or insurers develop additional communications. A change in available plans offered in the market also could affect the subsidy an individual receives. June 14, 2018: The American Cancer Society posted News titled: “ACS CAN filed legal brief in support of protections for people with serious health needs”. From the News: The American Cancer Society Cancer Action Network (ACS CAN) joined with four other national patient advocacy organizations today to file a legal brief or amicus curiae that describes the devastating impact patients would face if the district court rules the Affordable Care Act is not a valid law.Twenty states, led by Attorney General of Texas, recently filed a lawsuit, Texas v United States of America. They argue that the Affordable Care Act must be struck down because it cannot stand now that Congress repealed the tax penalty that a person receives if they do not have health care coverage.ACS CAN and the other patient groups urged the court in their legal brief to uphold the Affordable Care Act and to “recognize Congress’s clear intent to improve access to lifesaving health care for millions of Americans.”The Department of Justice (DOJ) is typically responsible for defending the country’s laws, but, in this case, the Department has filed a brief declining to defend the Affordable Care Act.The DOJ argues that certain protections the health care law guarantees for people with pre-existing conditions are invalid.If the Affordable Care Act is struck down, this could have dire consequences, leaving millions of Americans with serious illnesses like cancer unable to get health care coverage. Studies show that uninsured patients are less likely to be screened for cancer, and are more likely to be diagnosed at more advanced stages of their cancer when it is harder and more expensive to treat.“If people don’t have real health insurance – comprehensive health insurance – they die,” said Mary Rouvelas, senior counsel at ACS CAN.Since the Affordable Care Act was signed into law, more people have signed up for health care coverage and the uninsured rate has decreased by more than six percent nationwide.In a joint statement, ACS CAN and the patient groups said in reference to the health care law, “This has improved patients’ ability to prevent, detect, and treat their disease. For instance, there is already a small but statistically significant shift toward early-stage diagnosis for colorectal, lung, breast and pancreatic cancer in states that have increased access to health care through Medicaid because of the law.” June 14, 2018: HuffPost posted an article titled: “They Fought Over the Last Obamacare Lawsuit, But They Agree This One Is Nonsense”. It was written by Johnathan Cohn. From the article: Five scholars who argued with each other over past legal challenges to the Affordable Care Act have joined forces to file a friend of the court brief about a new lawsuit that could wreck the law.They all think the courts should reject the lawsuit. And they don’t think it’s a particularly close call.The lawsuit, Texas v. United States, comes from Republican officials in 20 states and alleges that the 2010 health care law is unconstitutional. Last week, the Justice Department declined to defend the law, breaking from the customary role the federal government plays when states challenge a federal statute……The case is now before a federal district judge in Texas. On Thursday, five well-known scholars were among those filing briefs urging the judge to reject the lawsuit.The five are Johnathan Adler from Case Western Reserve University, Nicholas Bailey from the University of Michigan, Abbe Gluck from Yale University, Ilya Somin from George Mason University, and Kevin Walsh from the University of Richmond……Adler was actually an architect of the lawsuit in King v Burwell, which could have crippled the Affordable Care Act’s newly created private insurance markets in a majority of states. He filed a brief in the case and, and in a series of articles and public appearances, frequently squared off with Bailey and Gluck, who collaborated on their own brief in defense of the law.The Supreme Court rejected that lawsuit in 2015. It was the second time the high court upheld the constitutionality of the law known as Obamacare. The first time was in 2012, in a case called NFIB v. Sebelius. Somin was an influential, high-profile supporter of the lawsuit and the author of a brief supporting it.As for Walsh, he is an expert on “severability,” which is the legal doctrine about when a court must strike down an entire law, or large parts of it, because it has found one piece to be unconstitutional. Justice Clarance Thomas just cited one of Walsh’s briefs in a recent Supreme Court decision on the subject… The Amici Curiae was posted by The Incidental Economist and is available to view as a PDF. June 14, 2018: CBS News posted an article titled: “Pre-existing conditions coverage at risk for more than thought?” From the article: …Two independent experts said Wednesday that the administration appears to be taking aim at provisions of the ACA that protect people in employer plans, not only the smaller pool of consumers who buy a policy directly from an insurer. The new Trump administration position was outlined last week in a legal brief filed by the Justice Department in a Texas case challenging the Obama health law.Workers “could face the prospect of insurance that doesn’t cover their pre-existing conditions when they enroll in a plan with a new employer,” said Larry Levitt of the nonpartisan Kaiser Family Foundation.University of Michigan law professor Nicholas Bailey said the administration does not appear to have thought through all the consequences of moving against one provision of a health law that has many complicated interlocking parts.“The lack of care on the brief is jaw-dropping,” said Bagley, who supports the Obama health law but considers himself a “free agent” critic of both sides. “There is no question that the Trump administration has to clarify what the scope of its injunction would be and grapple with the consequences of mowing down parts of the ACA.“For someone with a pre-existing condition thinking about switching jobs, the answer to that question could make a life-changing difference,” added Bagley……Nearly 160 million workers and family members have coverage through employers, although the number covered by small employers is much smaller. June 15, 2018: Two Cents posted an article titled: “You Could Be Denied Pre-Existing Conditions Coverage by Employer Health Plans if the ACA Is Repealed”. It was written by Alicia Adamcyzk. From the article: …If you don’t care much about the issue because you have insurance through your employer, it could affect you too. That’s because the provisions that the Trump administration is contesting apply to all private health coverage, including employer plans.Before the ACA, your employer plan couldn’t deny you coverage or charge you more, but it could exclude coverage for your pre-existing conditions for a year if you don’t maintain continuous coverage. That’s what the plans would revert to if the ACA’s provisions are overturned. (Large and small group plans would face worse outcomes.)As Timothy Jost, an Demetrius professor of law at Washington and Lee University writes, the biggest impact on those with employer insurance is that it would “lock you into” your jobs once again. The ACA gave some people more freedom to leave jobs and pursue entrepreneurial or freelance jobs, because they were guaranteed to find health insurance coverage… It also gives more freedom to leave an unfailing job you’re keeping simply for the benefits. That wasn’t a given before, and it could be on the line again… June 19, 2018: AHIP posted a statement titled: “AHIP Comments on Final Rule Expanding the Use of Association Health Plans”. From the statement: America’s Health Insurance Plans (AHIP) issued the following statement after the Department of Labor issued its final rule expanding the use of the Association Health Plans (AHP).“Every American should be able to get comprehensive health care coverage they can afford, and we support the goal of increasing competition and choice in ways that improve affordability. The final rule provides some important protections by ensuring consumers, including those with pre-existing conditions, do not face discrimination as new association plans are created, and by preserving state authority to regulate AHPs offered in their markets.“However, we remain concerned that broadly expanding the use of AHP’s may lead to higher premiums for consumers who depend on the individual or small group market for their coverage. Ultimately, the rule could result in fewer insured Americans and may put consumers at greater risk of fraudulent actors entering this market.“We will continue to work with the Administration, Congress, and state leaders to ensure that all coverage markets remain steady and reliable for all Americans.” June 19, 2018: The Washington Post posted an article titled: “House GOP plan would cut Medicare, Medicaid to balance budget”. It was written by Erica Werner. From the article: …The House Republican budget, titled “A Brighter American Future,” would remake Medicare by giving seniors the option of enrolling in private plans that compete with traditional Medicare, a system of competition designed to keep costs down but dismissed by critics as an effort to privatize the program. Along with other changes, the budget proposes to squeeze $537 billion out of Medicare over the next decade.The budget would transform Medicaid, the federal-state health-care program for the poor, by limiting per capita payments or allowing states to turn it into a block-grant program – the same approach House Republicans took in their legislation that passed last year to repeal the Affordable Care Act (the repeal effort died in the Senate, but the GOP budget assumes the repeal takes place). It also proposes adding work requirements for certain adults enrolled in Medicaid. Changes to Medicaid and other health programs would account for $1.5 trillions in savings.Social Security comes in for more modest cuts of $4 billion over the decade, which the budget projects could be reached by eliminating concurrent receipt of unemployment benefits and Social Security disability insurance.The budget also proposes a number of other cost-saving measures, some of which could prove unpopular if implements, such as adding more work requirements for food-stamp and welfare recipients and requiring federal employees – including members of Congress – to contribute more to their retirement plans…. A legal brief filed by ACS CAN, American Heart Association, American Lung Association, American Diabetes Association, and the National Multiple Sclerosis Society is available to read online. June 19, 2018: The Center on Budget and Policy and Priorities posted a CBPP statement titled “Greenstein: House Budget Committee 2019 Budget Continues Trend of Harsh, Deep Cuts” It was written by Robert Greenstein. From the statement: House Budget Committee Chairman Steve Womack’s new 2019 budget shows that the House majority’s fiscal priorities haven’t changed. The budget plan maintains the costly 2017 tax cuts, while making deep cuts in health care and basic assistance for struggling families, repealing the Affordable Care Act (ACA), and severely cutting funding over time for investments that can boost the nation’s productivity and thereby foster economic growth.The committee’s materials show that the budget would make nearly $6 trillion in cuts over ten years to entitlements and non-defense discretionary programs, including $2.1 trillion in health care alone, including to Medicaid, ACA premium tax credits, and Medicare. The budget incorporates the failed House ACA repeal bill, which, at the time the bill was considered, the Congressional Budget Office estimated would have taken away health coverage from 23 million Americans by 2026. (This estimate includes the effect of repealing the individual mandate, which Congress has since enacted.)… June 20, 2018: The United States Senate voted on H.R. 3 “Spending Cuts to Expired and Unnecessary Programs Act”. The vote was 48 YEAS to 50 NAYS. This bill required at least 51 YEA votes to pass. It only got 48 YEA votes. Senators who voted YEA: Alexander (R-TN)Barrasso (R-WY)Blunt (R-MO)Boozman (R-AR)Capito (R-WV)Cassidy (R-LA)Corker (R-TN)Cornyn (R-TX)Crapo (R-ID)Cruz (R-TX)Daines (R-MT)Enzi (R-WY)Ernst (R-IA)Fischer (R-NE)Flake (R-AZ)Gardner (R-CO)Graham (R-SC)Grassley (R-IA)Hatch (R-UT)Heller (R-NV)Hoeven (R-ND)Hyde-Smith (R-MS)Inhofe (R-CA)Isakson (R-GA)Johnson (R-WI)Kennedy (R-LA)Lankford (R-OK)Lee (R-UT)McConnell (R-KY)Moran (R-KS)Murkowski (R-AK)Paul (R-KY)Perdue (R-GA)Portman (R-OH)Rich (R-ID)Roberts (R-KS)Rounds (R-SD)Rubio (R-FL)Sasse (R-NE)Scott (R-SC)Shelby (R-AL)Sullivan (R-AK)Thune (R-SD)Tooney (R-PA)Wicker (R-MS)Young (R-IN) Senators who voted NAY: Baldwin (D-WI)Bennet (D-CO)Blumenthal (D-CT)Booker (D-NJ)Brown (D-OH)Burr (R-NC)Cantwell (D-WA)Cardin (D-MD)Carper (D-DE)Casey (D-PA)Collins (R-ME)Coons (D-DE)Cortez Masto (D-DE)Donnelly (D-IN)Duckworth (D-IL)Durbin (D-IL)Feinstein (D-CA)Gillibrand (D-NY)Harris (D-CA)Hassan (D-NH)Heinrich (D-NM)Heitkamp (D-ND)Hirono (D-HI)Jones (D-AL)Kaine (D-VA)King (I-ME)Klobuchar (D-MN)Leahy (D-VT)Manchin (D-WV)Markey (D-MA)McCaskill (D-MO)Menendez (D-NJ)Merkley (D-OR)Murphy (D-CT)Murray (D-WA)Nelson (D-FL)Peters (D-MI)Reed (D-RI)Sanders (D-VT)Schatz (D-HI)Schumer(D-NY)Smith (D-MN)Stabenow (D-MI)Tester (D-MT)Udall (D-NM)Van Hollen (D-MD)Warner (D-VA)Warren (D-MA)Whitehouse (D-RI)Wyden (D-OR) Senators who did not vote: McCain (R-AZ)Shaheen (D-NH) June 20, 2018: The Press Herald posted an article titled: “Senate rejects billions in Trump spending cuts as 2 Republicans, including Collins, vote ‘no'”. It was written by Erica Werner. From the article: The Senate on Wednesday rejected billions in spending cuts proposed by the Trump administration as two Republicans joined all Democrats in voting “no”.The 48-50 vote rebuffed a White House plan to claw back some $15 billion in spending previously approved by Congress – a show of fiscal responsibility that was encouraged by conservative lawmakers outraged over a $1.3 trillion spending bill in March.The House had approved the so-called “recessions” package earlier this month. But passage had never been assured in the Senate, where a number of Republicans had been cool to the idea from the start.Nevertheless, Wednesday’s outcome was startling because one of the “no” votes came from Sen. Richard Burr (R-NC), who does not normally buck the White House or leadership. Burr’s office had no immediate comment.Sen. Susan Collins (R-Maine), a moderate who is one of the Republicans who most frequently sides with the Democrats, cast the other ‘no’.The cuts in the recessions package included $7 billion from the Children’s Health Insurance Program, mostly from an expired account that can no longer be used; $5 billion from Energy Department programs, including a little-used loan program for advanced technology vehicle manufacturing; and smaller amounts from a variety of other programs ranging from Forest Service land acquisition to the Millennium Challenge Corp… June 20, 2018: Politicus USA posted an article titled: “As America Is Distracted By Trump Child Abuse, GOP Moves To Gut Medicare And Medicaid”. It was written by Jason Easley. From the article: While the American people are rightly outraged by the Trump administration’s abuse abuse of migrant children, House Republicans proposed a budget that would gut Medicare and Medicaid.The 2019 budget that Republicans are working on in the House Budget Committee would pay for tax cuts with a gutting of Medicare and Medicaid.According to The Center for Budget and Policy Priorities, “House Budget Committee Chairman Steve Womack’s new 2019 budget shows that the House majority’s fiscal priorities haven’t changed. The budget plan maintains the costly 2017 tax cuts, while making deep health care and basic assistance for struggling families, repealing the Affordable Care Act (ACA), and severely cutting funding over time for investments that can boost the nation’s productivity and thereby foster economic growth. The committee’s materials show that the budget would make nearly $6 trillion in cuts over ten years to entitlement and non-defense discretionary programs, including $2.1 trillion in health care alone, including cuts to Medicaid, ACA premium tax credits, and Medicare. The budget incorporates the failed House ACA repeal bill which, at the time the bill was considered, the Congressional Budget Office estimated would have taken away health coverage from 23 million Americans by 2026.”… June 20, 2018: Forbes posted an article titled: “Once More Into The Breach: Conservative Think Tankers Publish A New Obamacare Replacement”. It was written by Avik Roy. Conservative health care think tank scholars have published a new proposal to repeal and replace Obamacare, hoping that they can persuade Congress to take up the issue one more time before November. Can it succeed where prior efforts have failed?The proposal, entitled “The Health Care Choices Proposal: Policy Recommendations to Congress – Why Congress Much Act,” was published by the Health Policy Consensus Group, a kind of conservative health wonk Jedi Council led by Grace-Marie Turner of the Galen Institute, who is also a Forbes contributor. (I am also a participant in the Consensus Group.)The plan emerged from the aftermath of the 2017 effort by Bill Cassidy (R., La.) and Lindsey Graham (R., S.C.) to put forth an Obamacare replacement after all the previous efforts by congressional GOP leadership had failed. The Graham-Cassidy bill…was designed to preserve the vast majority of Obamacare’s spending on the uninsured, but reformat that spending as block grants to state governments.The critical flaw in Graham-Cassidy is that it bore the potential to make health insurance markets work, not better, because due to design flaws in the bill, most states would have been strongly incentivized to eliminate their private individual insurance markets and replace them with an enlarged expansion of Medicaid, a program whose enrollees have health outcomes no better than those who are uninsured.…The Consensus Group proposal improves upon Graham-Cassidy by requiring that “at least 50% of the block grant goes toward supporting people’s purchase of private health coverage” in the individual insurance market. Under the new program, states would be required to offer Market enrollees the opportunity to purchase “commercially available coverage” with their Medicaid dollars, and plans sold under the block grants would be exempted from costly Obamacare rules, like 3:1 age bands that double the triple the costs of insurance for young people.The proposal would also double contribution limits to health savings accounts, and it would reform the limits on what kinds of insurance can be associated with HSAs:The Proposal would make more HSA-compatible. Today, in order to be HSA-compatible, a policy must have a deductible of a least $1,350 ($2,700 for families). The average Obamacare Silver plan had deductible of at $4,033 ($8,292 for families). In 2016, more than four of every five plans on the federal exchange had deductibles greater than the legal minimum for HSAs, but less than a fifth were HSA-eligible. This proposal would change the requirement to qualify, so that any plan with an actuarial value less than a specified (e.g., 70%, 80%) could be HSA-compatible……The likelihood that the Consensus Group proposal becomes law is low. And that’s despite the fact that its focus is narrow; it doesn’t attempt to reform the pre-Obamacare Medicaid program or any of our other health are entitlements, nor does it try to tackle the underlying reasons why health care is so expensive in the first place.Graham-Cassidy died because there weren’t enough votes in the Senate to support it. Republicans control 51 seats in the Senate right now, and one of those belongs to John McCain (Ariz.), who is battling brain cancer and is rarely in Washington. Hence, every other GOP senator has to vote “aye” for any health care bill to pass.And they can’t get to 50. Kentucky Sen. Rand Paul (R.) has repeatedly expressed his opposition to any plan that replaces Obamacare with subsidies for the uninsured. Mike Lee (R. Utah) has also been generally unfriendly to robust replacement bills. And that’s before you even get to the moderate Republican senators, who have their own suite of concerns. Democrats are almost certainly unwilling to entertain a proposal in which the word “uninsured” appears exactly zero times… June 21, 2018: John Yarmuth (Ranking Member of the House Budget Committee), (Kentucky – Democrat) posted a statement on the House Committee on the Budget Democrats website. From the statement: Kentucky Congressman John Yarmuth, Ranking Member of the House Budget Committee, issued the following statement after the Republican majority voted to pass the House Republican 2019 budget and rejected every amendment offered by Democrats:“Today, during consideration of the Republican budget, Democrats offered amendment after amendment to advance the needs and priorities of the American people. We proposed protecting Medicare, Medicaid and Social Security, ending extreme cuts to infrastructure, education and nutrition assistance, and even ensuring that surviving military spouses receive full benefits with no penalties. At every turn, Republicans voted to protect their $2 trillion in tax cuts for millionaires and big corporations instead of American families.” June 21, 2018: Topher Spiro (Senior Fellow, Economic Policy and VP, Health Policy at American Progress) posted a thread on his verified Twitter account that started with this tweet: “BREAKING: The House GOP just voted a budget bill out of committee that fast tracks ACA repeal and $2 TRILLION in cuts to Medicare and Medicaid. We need to flood them with calls to prevent a floor vote.” June 21, 2018: USA Today posted an article titled: “Obamacare: Outreach groups nervous as Trump remains silent on funding.” It was written by Ken Alltucker. From the article: A year after steep cuts to a key Affordable Care Act outreach program, the Trump administration has remained quiet on how much it will fund nonprofit and grass-roots groups that help people sign up for health insurance.The federal navigator program funds groups that help people to sign up for health insurance on the Obamacare federal and state insurance exchanges or assist low-income adults and children sign up for Medicaid coverage.Navigator groups located in federal exchange states are funded through September but have no idea how much money will be available then. The six-week open enrollment period that allow consumers to choose a plan for the upcoming year begins Nov. 1……The Trump administration, which has been critical of the efficiency of these groups, has reshaped the Obama-era program to operate with limited resources, according to an HHS draft rule.Under new HHS regulations that took effect June 18, navigator groups would no longer need to be physically located in the states they serve. The new regulations also eliminate a requirement that at least one navigator group in a community be a consumer-focused nonprofit……Administration officials would not say when the funding details will be publicly released leaving navigator groups in limbo on budgets to prepare for this year’s six-week enrollment starting Nov. 1.Last year, the Trump administration cut funding to the navigator program more than 40 percent weeks before the start of signups. While the administration has not publicly revealed budgets for the year. HHS officials noted that limited resources are a driving factor for the proposed regulatory overhaul this year… June 22, 2018: Nancy Pelosi (Minority Leader of the U.S. House of Representatives) (California – Democrat) posted a tweet on her verified Twitter account: “It’s been 6 months since Republicans forced the $1.5 trillion #GOPTaxScam for the rich. It’s been ~24 hours since they voted to steal over $2 trillion from Medicaid, Medicare, Social Security and other key investments. They really don’t care about the harm they’re inflicting.” June 22, 2018: Sun-Sentinel posted an article titled: “South Florida’s 3 Obamacare providers file proposals to return in 2019”. It was written by Ron Hurtibise. From the article: …Three companies that offered 2018 plans in South Florida are back – market leader Florida Blue, which has been offering a wide array of plans to fit all budgets and circumstances – plus narrow-network, lower-cost alternatives Molina Healthcare and Ambetter.All three submitted 2019 rate proposals with the Florida Office of Insurance Regulation as required by June 20, along with four other companies that filed to sell plans in other areas of the state.In all, rate increases proposed by eight companies offering ACA-compliant plans on and off the exchange, average 8.8 percent, according to a news release by the state office late Friday afternoon.That compares with a 17.8 percent increase requested a year ago by the same companies….…Of the 1.7 million Floridians who enrolled in 2018 marketplace plans, 92 percent qualified for subsidies and saw an average $595 monthly premium reduced to $70, according to data maintained by the Department of Health and Human Services. In the tricounty region, 762,000 are enrolled……A new company has even filed to offer ACA plans in the state. Oscar Health, which currently sells plans in California, Texas, and New York, on Thursday announced plans to expand into Florida, Michigan and Arizona in 2019……Market giant Florida Blue, which absorbed most of the policies abandoned by competitors Aetna, Cigna, UnitedHealthcare and Humana after Obamacare’s first three years, plans to remain in all 67 Florida counties… June 24, 2018: Forbes posted an article titled “Poll: 66% Of Voters Oppose Trump DOJ’s Move To Gut Patient Protections”. It was written by Bruce Japsen. From the article: By a 2-to-1 margin, U.S. voters disapprove of the U.S. Justice Department’s decision to support a lawsuit that would eliminate popular protections for patients with preexisting conditions under the Affordable Care Act, a new poll shows……The survey of more than 1,000 likely voters by Hart for the group Protect Our Care was conducted June 11 to 17 following the action by Republican state attorneys general to challenge the constitutionality of consumer insurance programs like the ban on refusing coverage or charging higher premiums to Americans with pre-exiting conditions.The poll, which is the latest to show growing support for the ACA, and its consumer protections in particular, shows 66% of voters disapprove of the Trump Justice Department’s move and nearly half, or 47% of all voters “strongly disapprove” of the lawsuit gutting the ACA’s consumer protections. Only 11% strongly approve, the survey shows……Already, providers of medical care and health insurers have voiced strong opposition to the Justice Department’s brief in support of Texas and 19 other states attempt to declare as unconstitutional protections for patients with pre-existing conditions. June 26, 2018: The Kansas City Star posted an article titled: “Insurer plans to expand Obamacare offerings into Missouri counties in KC area”. It was written by Andy Marso. From the article: Another insurance company has filed to sell plans on the Affordable Care Act exchange in Kansas City next year, possibly bringing the total to three just one year after it appeared the city might have only one option.Minnesota-based Medica announced this week it has filed documents with the Missouri Department of Insurance to sell its Select plan in Cass, Clay, Jackson and Platte counties.The plan, which limits hospital coverage to St. Luke’s Health System locations, is now offered only to residents of Johnson and Wyandotte counties in Kansas……Medica’s announcement is the latest in a slew of market changes for the area’s Affordable Care Act, commonly called Obamacare, marketplace.Major insurers like UnitedHealthcare and Blue Cross and Blue Shield of Kansas City have gotten out, but new players like Medica and Centene, with its “Ambetter” plans, have jumped in.The one constant in the Missouri counties of the metro over the last few years has been Cigna. If the Connecticut-based insurer and Centene stay for 2019, then people in Jackson, Clay, Cass and Platte counties will have three companies to choose from when open enrollment starts in November.Johnson County and Wyandotte County have also seen turnover the last few years. But according to the Kansas Insurance Department, Medica, Centene and Blue Cross Blue Shield of Kansas have again filed their intent to sell 2019 plans that are similar to what they’re offering those year. That would be Medica throughout the state, Centene in Johnson County and Wyandotte County, and BCBS Kansas in every county except Johnson and Wyandotte… June 27, 2018: The New York Times posted an article titled: “The Stealth Campaign to Kill Off Obamacare”. It was written by Jay Hancock. From the article: In 2010, before the Affordable Care Act was passed by Congress, the pharmaceutical industry’s top lobbying group was a very public supporter of the measure. It even helped fund a multimillion-dollar TV ad campaign backing passage of the law.But last year, when Republicans mounted an aggressive effort to repeal the law, the group made a point of staying outside the fray. “We’ve not taken a position,” Stephen Ubl, head of the organization, the Pharmaceutical Research and Manufacturers of America, known as PhRMA, said in an interview March 2017.That stance, however, was at odds with its financial support of another group, the American Action Network, which was heavily involved in the effort to repeal the act, often referred to as Obamacare. The network spent an estimated $10 million on an ad campaign designed to build voter support for its elimination.“Urge him to repeal and replace the Affordable Care Act now,” one ad running in early 2017 advised viewers to tell their congressman. That and similar material (including robocalls) paid for by the American Action Network ran numerous times last year in 75 congressional districts.PhRMA was one of AAN’s biggest diners the previous year, giving it $6.1 million, federal regulatory filings show. And PhRMA had a substantial interest in the outcome of the repeal efforts. Among other actions, the Republican-backed bill would have eliminated a fee the companies pay the federal government, one estimated at $28 billion over a decade.But there was no way the public could have known at the time about PhRMA’s support of the network or the identity of the other deep-pocketed financiers behind the group……PhRMA’s $6.1 million, unrestricted donation to AAN was its single-biggest grant in 2016, dwarfing its $130,000 contribution to the same group the year before. Closely associated with House Republicans – AAN has a former Republican senator and two former Republican House members on its board – the group backed the G.O.P. health bill intended to replace the Affordable Care Act. It also supported the successful Tax Cuts and Jobs Act of 2017, which reduced corporate taxes by hundreds of billions of dollars over a decade… June 27, 2018: SunSentinel posted an article titled: “South Florida’s 3 Obamacare providers file proposals to return in 2019”. It was written by Ron Hurtibise. From the articles: …The three companies that offered 2018 plans in South Florida are back – market leader Florida Blue, which has been offering a wide array of plans to fit all budgets and circumstances – plus narrow-network, lower-cost alternatives Molina Healthcare and Ambetter.All three submitted 2019 rate proposals with the Florida Office of Insurance Regulation as required by June 20, along with four other companies that filed to sell plans in other areas of the state.In all, rate increases proposed by eight companies offering ACA-compliant plans on and off of the exchange, average 8.8 percent, according to a news release by the state office late Friday afternoon.That compares with a 17.8 percent increase requested a year ago by the same companies……Of the 1.7 million Floridians who enrolled in 2018 marketplace plans, 92 percent qualified for subsidies and saw an average $595 monthly premium reduced to $70, according to data maintained by the Department of Health and Human Services. In the tricounty region, 762,000 are enrolled……A new company has even filed to offer ACA plans in the state. Oscar Health, which currently sells plans in California, Texas and New York, on Thursday announced plans to expand into Florida, Michigan and Arizona in 2019… June 27, 2018: Kaiser Family Foundation posted an article titled: “Poll: Two-thirds of Voters Say a Candidate’s Position on Pre-existing Conditions is Important to their Vote, More than Say the Same about Drug Costs, ACA Repeal or Medicare-for-all”. From the article: About two-thirds (65%) of voters say a candidate’s support for continued protections for people with pre-existing health conditions is either the “single most important factor” or “very important” to their vote in the upcoming midterms elections, finds the Kaiser Family Foundation tracking poll.That’s a larger share than says the same about other health care issues, including bringing down prescription drug costs (58%), repealing the Affordable Care Act (53%), stabilizing the ACA marketplaces (52%), or passing a national health plan or Medicare-for-all (48%), the poll finds.There are differences by partisan identification. Eight in 10 Democratic (81%) and nearly two-thirds (63%) of independent voters say the issue is at least “very important” to their vote – making it top health care issue for both groups of voters. About half (51%) of Republican voters say the same, ranking the issue below repealing the ACA (58%) among Republicans….…Almost six in 10 Americans (57%) say that they or someone in their household has a pre-existing condition of some sort, the poll finds. This includes majorities of men and women, and majorities in all age groups except those under 30.Among the general public, large majorities say that the ACA’s provisions that bar insurers from discriminating against people with pre-existing conditions are “very important” to them, the poll finds… June 29, 2018: NPR posted an article titled “Federal Judge Blocks Medicaid Work Requirements In Kentucky”. It was written by Alison Kodjak. From the article: A federal judge has blocked work requirements for Medicaid patients in Kentucky, just days before new rules mandated by Gov. Matt Bevin’s administration were set to go into effect.In Friday’s ruling, U.S. District Judge James Boasberg called the Trump administration’s approval of the program, Kentucky HEALTH, “arbitrary and capricious”.He writes that in approving Kentucky’s work requirement proposal, Health and Human Services Secretary Alex Azar “never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid.”The judge pointed out that Azar did not mention that 95,000 people could lose coverage under the plan – an oversight that he called “glaring”……Bevin filed a counter lawsuit in February and has threatened to dismantle Kentucky’s Medicaid expansion if the courts do not allow him to add the work requirement.HHS approved Bevin’s request to change Kentucky’s Medicaid program in January. It requires “able bodied” Medicaid recipients to either find work, do job training or do volunteer work to be eligible for Medicaid benefits. It was the first state to get such approval, after Seema Varma, the administrator for the Centers for Medicare and Medicaid Services, said she would look favorably on such proposals.Verma said in a statement that she is disappointed by the decision..…She said the agency is talking with the Justice Department to decide whether to appeal……Verma and Azar have argued that Medicaid beneficiaries will benefit from what’s known as “community engagement” requirements because finding work will help lift them from poverty, and therefore improve their health.But the judge didn’t buy that argument……HHS has approved work requirements for Medicaid in four states. An additional seven states have requests awaiting agency approval, according to the Kaiser Family Foundation. The ruling is available to view online. The case is called “Ronnie Maurice Stewart, et. al., v. Alex M. Azar II, et. al.,” From the ruling: In 2010, Congress enacted the Patient Protection and Affordable Care Act – popularly known as Obamacare – which is “a comprehensive national plan to provide universal health insurance coverage” across the nation… …One central component of that statute was an expansion of Medicaid, allowing states to provide “health care to all citizens whose income falls below a certain threshold.”… …The “expansion,” the Supreme Court has held, represented “a shift in kind, not merely degree.”… …While the “original program was designed to cover medical services for four particular categories of the needy: the disabled, the blind, the elderly and needy families with dependent children,” the Affordable Care Act “transformed” Medicaid “into a program to meet the health care needs of the entire non elderly population with income below 133 percent of the poverty level……Defendants in this case sought to roll back those reforms. Upon assuming office in March 2017, Defendant Seema Verma, the Administrator for the Centers of Medicare & Medicaid Services – along with then-Secretary of the Department of Health and Human Services Tom Price – immediately circulated a letter to the Governors of all states to share her belief that the ACA’s Medicaid expansion”was a clear departure from the core, historical, mission of the program.”……The letter encouraged states to apply for “waiver[s]” of some of the program’s coverage requirements – especially for the expansion group – promising to “fast-track” approval of such petitions……Kentucky is one state to board that train. After the ACA went into effect, it elected to broaden Medicaid to include the expansion population, and by April 2016, more than 428,000 new residents had thereby received medical assistance. In July 2017, however, the state submitted an experimental plan to CMS called “KY HEALTH,” which is made up of several components, most significantly Kentucky HEALTH. That latter program promised to “comprehensively transform” its Medicaid program.Under that plan, the state would impose “community engagement” requirements for the expansion population, along with some of the traditional population as well. This new mandate would require that those recipients work (or participate in other qualifying activities) for at least 80 hours each month as a condition of receiving health coverage. The project also called for, among other things, increased premiums and more stringent reporting requirements. Consistent with CMS’s earlier invitation, the Secretary approved Kentucky’s application on January 12, 2018, waiving several core Medicaid requirements in the process.Plaintiffs in this case are fifteen Kentucky residents, each of whom is currently enrolled in the state’s Medicaid program. Together, they fear that that Kentucky HEALTH will relegate them to second-class status within Medicaid, putting them and others “in danger of losing” their health insurance altogether. They have thus brought this action to challenge the Secretary’s approval of Kentucky HEALTH.Although the Secretary is afforded significant deference in his approval of pilot projects like Kentucky’s, his discretion does not insulate him entirely from judicial review. Such review reveals that the Secretary never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid. This signal omission renders his determination arbitrary and capricious. The Court, consequently, will vacate the approval of Kentucky’s project and remand the matter to HHS for further review. The ruling included more specific details about the Kentucky HEALTH program: Community -engagement requirement: which requires beneficiaries to spend at least 80 hours per month on qualifying activities (including employment, job-skills training, education, community service, and participation in SUD treatment) or lose their Medicaid coverage.Limits on retroactive eligibility: which will excuse the state from “provide[ing] three months of retroactive eligibility for beneficiaries receiving coverage through the Kentucky HEALTH program; except for pregnant women and former foster care youth”Monthly premiums: including premiums varied based on income and/or length of time enrolled in Medicaid;Limits on non-emergency medical transportation: which “relieve Kentucky of the requirement to assure non-emergency medical transportation to and from providers for the new adult group” – i.e. adults without disabilities, except for those who are medically frail, former foster-care youth, or pregnant;Reporting requirements: which mandate that individuals provide information for an annual redetermination and report changes in income or circumstances that affect Medicaid eligibility within 10 days; andLockouts: which allow the state to deny Medicaid coverage for up to six months for any beneficiary who (a) has income above 100% of the FPL and (b) failed to meet her premium or reporting requirements. Other interesting parts of the ruling include: …In this case, Plaintiffs accuse HHS of “take[ing] by regulatory fiat what it could not accomplish in Congress.”…The Secretary and Kentucky, they say, sought to do little more than “knock people off Medicaid and undermine the Medicaid expansion enacted by Congress.”… With that in mind, their nine-court Complaint – which relies almost exclusively on the APA – challenges nearly every component of Kentucky HEALTH……Considering all of its aspects, Plaintiff say Kentucky HEALTH might strip them of Medicaid coverage altogether. Generally, “an eligible recipient… ha[s] a concrete interest in Medicaid benefits.”…The D.C. Circuit had “no doubt,” for example, that agency actions “threaten[ed] an individual’s ability to obtain Medicaid coverage… satisf[ied] the injury element of constitutional standing……The Secretary does not dispute that any Plaintiffs subject to higher premiums would suffer a cognizable injury. Instead, he suggests that each named Plaintiff might be exempt from this requirement. Kentucky HEALTH, however, excepts only the following groups from premium payments: (1) former foster-care youth; (2) pregnant women; and (3) medically frail individuals. Although Kentucky has not yet defined medically frail, several Plaintiffs aver that they are “healthy and do not have any ongoing medical problems.”……CMS suggest that these Plaintiffs might nevertheless meet one of the other two exemptions… but the Court cannot agree. Quite obviously, Roode, a 39-year-old man, is not a pregnant woman. Medical advances notwithstanding, Kasey, a 56-year-old woman, is also unlikely to meet that criterion…. Plaintiffs also represent in their briefing that they will not “be exempted as former foster care youth.”…The Court therefore finds it likely that at least two Plaintiffs would be required to pay increased premiums and thus would suffer a concrete injury from Kentucky HEALTH. This is all that is needed to challenge the program……Kentucky tries to muddy the waters, arguing that Plaintiffs cannot satisfy the repressibility prong because “if [they] prevail in this action, the Commonwealth will not continue participating in expanded Medicaid.”… While the Governor has indeed issues an Executive Order directing the Commonwealth to “unexpand” Medicaid if any aspect of Kentucky HEALTH is invalidated… that Order has no bearing on the standing analysis here. The Executive Order calls for the Commonwealth’s Medicaid agency “to take the necessary actions to terminate Kentucky’s Medicaid expansion program” only after a final court judgement… The EO cannot take effect before this Court’s decision. Even if Kentucky were able to “unexpand” Medicaid (far from a foregone conclusion), Plaintiffs would have, at a minimum, momentary relief….…At bottom, the record shows that 95,000 people would lose Medicaid coverage, and yet, the Secretary paid no attention to that deprivation. Nor did he address how Kentucky HEALTH would otherwise help “furnish… medical assistance.” In other words, he glossed over “the impact of the state’s project” on the individuals whom Medicaid “was enacted to protect.”…By doing so, he “failed to consider adequately” a salient purpose of Medicaid, and, thus, an important aspect of the program. The Court, consequently, cannot validate his approval of Kentucky HEALTH……CONCLUSIONFor the foregoing reasons, the Court will deny Defendants’ Motions for Summary Judgement. It will also grant Plaintiff’s Motion for Summary Judgement via Count VII, vacate the Secretary’s approval of Kentucky HEALTH, and remand to the agency. A contemporaneous Order to that effect will issue this day. July 1, 2018: Forbes posted an article titled: “Trump’s Medicaid Work Rules Were Adding To Costs Even Before A Judge Blocked Them”. It was written by Bruce Japsen. From the article: The Trump administration’s efforts to require Medicaid patients to work has already been adding to costs from a new layer of administrative bureaucracy that began even before a federal judge ruled against them in one state, insurers say.U.S. District Judge James Boasberg said Trump’s health Secretary “never adequately considered whether Kentucky HEALTH would in fact furnish medical assistance to its citizens, a central objective of Medicaid.” Thus, that “omission renders his determination arbitrary and capricious.”The ruling Friday not only puts in doubt the effort to implement Medicaid work requirements proposed earlier this year by the Trump administration and the Centers for Medicare & Medicaid Services (CMS) under Seema Verma. But the work requirement implementation continues to be a headache for health insurers that administer Medicaid benefits for low income Americans as the health plans predicted it would be……Prior to Trump and Verma, past administrations found work requirements “could undermine access to care and were thus inconsistent with the purposes of Medicaid,” background in the case says. In Kentucky, the work requirement added an annual reporting requirement and “redetermination” of eligibility as well as other rules patients, health plans and medical providers had to take into consideration when caring for patients.If the new requirements are still pursued in Kentucky and elsewhere, providers and insurers predict patients could face gaps in care and cause Medicaid patients to avoid seeing a doctor, and get sicker down the road and end up costing taxpayers and the health system more money in the long run……With Medicaid work requirements, there’s a worry of an extra layer of burden to vet people who largely already have jobs. Studies show that most Medicaid beneficiaries are working and adding more paperwork could lead to unnecessary gaps in coverage… July 2, 2018: The Hill posted an article titled: “Ky. governor cancels Medicaid dental, vision benefits after losing work requirement ruling”. It was written by Peter Sullivan. From the article: Kentucky Gov. Matt Bevin’s (R) administration is canceling dental and vision benefits for thousands of people on Medicaid in the state following a judge blocking the state’s Medicaid work requirements.The cancellation of dental and vision coverage for almost 500,000 enrollees in the state’s Medicaid expansion is “an unfortunate consequence of the judge’s ruling,” Doug Hogan, a spokesman for the Kentucky Cabinet for Health and Family Services, told the Louisville Courier-Journal.Democrats denounced the move and said they did not think Bevin had the legal authority to cancel the benefits……Under Bevin’s Medicaid proposal, along with work requirements, enrollees would have had to earn dental and vision benefits through completing activities like taking classes or searching for a job.With the proposal blocked in court, Bevin’s administration is now canceling dental and vision benefits altogether……Bevin has threatened to cancel the state’s Medicaid expansion altogether if the work requirements are struck down. Friday’s ruling can be appealed, though, so the issue is not fully resolved. July 2, 2018: MHPA (Medicaid Health Plans of America) posted a statement titled: “Statement from Jeff M. Myers, president and CEO of Medicaid Health Plans of America, on the US District Court’s rejection of the Kentucky HEALTH waiver”. From the statement: Today, U.S. District Judge James Boasberg rejected HHS Secretary Azar’s approval of the Kentucky HEALTH waiver that included not only Medicaid work requirements provisions, but other changes to the program as well.MHPA shares the concerns raised by Judge Boasburg about how the proposal would affect Medicaid enrollees. Our member health plans in Kentucky and other states that have proposed work requirements have invested significant resources in an attempt to address these issues. However, the ruling now puts in limbo all of the state infrastructure to implement these measures that our plans have been building.Furthermore, the states where work requirements, community engagement, co-pays, etc., were used to find legislative compromise now must perform a delicate balancing act to bring needed health care to hundreds of thousands of the working poor via state expansion. We encourage the prompt legal review of these issues to provide clarity and direction to all stakeholders.We expect that the ruling will be appealed. In the meantime, we are committed to working with our state partners over the next several months to determine the best path forward. July 6, 2018: Los Angeles Times posted an article titled: “South Carolina governor cuts healthcare to take antiabortion stand”. From the article: South Carolina Gov. Henry McMaster removed $16 million for healthcare from the state budget, saying Friday he wanted to make sure no taxpayer money goes to abortion providers.The Republican governor said he was keeping a promise he made repeatedly as he campaigns for a full term, disagreeing with Democrats and some Republicans who said Planned Parenthood gets less than $100,000 of the money and all of it goes for family planning and not abortion……Planned Parenthood said the veto is a “political stunt” and the practical effect will be to remove birth control, testing for sexually transmitted disease and even cancer screenings for hundreds of thousands of poor women on Medicaid……Republicans have been fighting over the “Family Planning” line in the budget for months. McMaster did not veto the entire $34 million in the item, with his office saying eliminating all that money would keep 700,000 women and children from getting prescriptions through Medicaid.Democrats and Republicans – even those adamantly against abortions – called removing the money from the budget shortsighted because so little goes to Planned Parenthood in the first place and removing ti from the spending plan could mean less money for things like law enforcement or help for families with children with autism……McMaster said he would prefer if the federal government approves his request for a waiver that would allow South Carolina to withhold any public funds from Planned Parenthood, but his office does not know when that might be considered. July 7, 2018: CMS (Centers for Medicare & Medicaid Services) posted a press release titled: “United States Court Ruling Puts Risk Adjustment On Hold”. From the press release: On February 28, 2018, the United States District Court for the District of New Mexico issued a decision invalidating use of the statewide average premium by the Center for Medicare & Medicaid Services (CMS) in the risk adjustment transfer formula established under section 1343 of the Patient Protection and Affordable Care Act for the 2014 – 2018 benefit years. The ruling prevents CMS from making further collections or payments under the risk adjustment program, including amounts for the 2017 benefit year, until the litigation is resolved.In light of a contrary decision by the United States District Court for the District of Massachusetts, the government moved the New Mexico district court to reconsider its decision, and CMS is currently awaiting the court’s ruling. CMS is seeking a quick resolution to the legal issue raised and will inform stakeholders of any update to the status of collections or payments at an appropriate future date. The calculated risk adjustment transfer amounts for the 2017 benefit year are $10.4 billion, which includes transfers across catastrophic, small group, and individual non-catostrophic risk pools……The New Mexico district court’s ruling bars CMS from collecting or making payments under the current methodology, which uses the statewide average premium. This aspect of the risk adjustment methodology was promulgated as part of a regulation first issued by the Obama Administration in 2013. CMS will provide additional guidance shortly on how it will handle other issues relating to risk adjustment payments, including EDGE server data collection operations, appeals of 2017 risk adjustment amounts, and how issuers should treat risk adjustment amounts in the calculation of medical loss ratios… July 7, 2018: Protect Our Care posted a statement titled: “Protect Our Care Statement On Historic DOJ Health Care Sabotage”. From the statement: After a partisan team of Department of Justice lawyers decided to abandon the rule of law in order to help a lawsuit that could eliminate the Affordable Care Act overnight, Protect Our Care Campaign Director Brad Woodhouse made the following statement:“The Trump Administration just made history by undermining the rules of law in order to continue its no-holds barred war on American health care. By abandoning its legal and constitutional responsibilities to defend the law of the land, Jeff Sessions’ Department of Justice is prioritizing a political vendetta over centuries of legal precedent. If Trump and Sessions have their way, the Affordable Care Act and Medicaid expansion will disappear overnight, stealing coverage from millions of Americans, winding back the clock on people with pre-existing conditions, and undermining the stability of the U.S. economy. Tonight, as the President and his Administration launch their most dangerous sabotage effort yet, we are seeing just how far Republicans are willing to go in their quest to undermine the American health care system. And by sowing even more uncertainty into the health care markets, tonight’s action could encourage insurance companies to propose even higher rate increases than the double-digit hikes already threatening to hit American families next year.” July 7, 2018: BlueCross BlueShield posted a statement titled: “Blue Cross Blue Shield Association Statement on Risk Adjustment Payment Freeze.” From the statement: The Blue Cross Blue Shield Association issued the following statement today from President and CEO Scott Serota:“We are extremely disappointed that the administration has frozen payment transfers under the Affordable Care Act’s (ACA) risk adjustment program, which is designed to keep costs down for consumers while meeting the medical needs of those requiring significant care. Risk adjustment is a Congressionally-mandated program that supports both the individual and small group health insurance markets.“Without a quick resolution to this matter, this action will significantly increase 2019 premiums for millions of individuals and small business owners and could result in far fewer health plan choices. It will undermine Americans’ access to affordable coverage, particularly for those who need medical care the most.“CMS should use all legal avenues available to make the payments on schedule and should do so to protect consumers.“Risk adjustment is a concept that has been long supported and embraced by both Republicans and Democrats through programs like Medicare Advantage. The Program does not cost taxpayers any money and has worked effectively to help balance the cost of caring for those with significant health need by ensuring that health plans are able to enroll all consumers, regardless of their health status.“The actions taken today will create turmoil not only for the individual market – particularly as insurers finalize their offerings for the next open enrollment that begins in November – but also for the millions of businesses that rely on the small group market to provide affordable insurance options for their employees.“Risk adjustment is a mandatory program under federal law. CMS should take immediate action to reinstate these payment transfers to ensure the market works as intended under the law and that coverage for millions of Americans is not disrupted.” July 7, 2018: AHIP posted a statement titled: “AHIP Statement on the Freeze of Risk Adjustment Payments for the Individual and Small Group Markets.” From the statement: America’s Health Insurance Plans (AHIP) issued the following statement following the Administration’s decision to freeze risk adjustment payments for the individual and small group markets, in light of the decision earlier this year by the United States District Court for the District of New Mexico:“We all agree that Americans deserve affordable, comprehensive coverage and care – regardless of whether they are sick, healthy, or have a pre-existing condition. Because different plans cover different people, the health of the people they server differs as well. The risk adjustment program helps ensure coverage is available for high-need patients by sharing the cost of covering them. If a plan covers more patients who require more health care services, that plan receives funds from other plans that cover fewer high-ned patients – all without using any taxpayer dollars.”“We are very discouraged by the new market disruption brought about by the decision to freeze risk adjustment payments. This decision comes at a critical time when insurance providers are developing premiums for 2019 and states are reviewing rates. This decision will have serious consequences for millions of consumers who get their coverage though small businesses or buy coverage on their own. It will create more market uncertainty and increase premiums for many health plans – putting a heavier burden on small businesses and consumers, and reducing coverage options. And costs for taxpayers will rise as the federal government spends more on premium subsidies.“We agree that a quick resolution is needed to avoid greater harm to individual and small group markets. More than ever, American business and families want affordable coverage and care they need and deserve. We encourage the Administration to reevaluate its decision and work with all stakeholder to make health care more affordable for all Americans.” July 8, 2018: NPR posted an article titled: “Trump Administration Freezes Payments Required By the Affordable Care Act”. It was written by Maggie Penman. From the article: The Trump administration said Saturday that it is temporarily halting billions of dollars in payments designed to help insurers meet the Affordable Care Act requirement that they provide coverage regardless of whether a person is healthy or sick.The administration said it was withholding $10.4 billion in the so-called “risk adjustment” payments, citing a district court ruling from earlier this year in New Mexico. While the administration says it is required to stop payments because of the court decision, insurers say the move could result in higher premiums for millions of individuals and small businesses……The New Mexico ruling fond fault with the formula the government used to calculate the payments, saying it was “arbitrary and capricious”. But another district court in Massachusetts upheld the formula.The announcement came as insurers were awaiting an annual report that usually comes at the end of June, informing them of whether they owe money into the risk adjustment program or will be paid out for the previous year. Insurers say the sudden halting of those payments creates uncertainty at a critical time, as they are currently developing their premiums for 2019……”Insurers hate uncertainty, and when faced with it tend to raise premiums to hedge their bets,” says Larry Levitt, Senior Vice President at the Kaiser Family Foundation. He says halting the risk adjustment program will disrupt the individual markets, and might even cause insurers not to participate next year.“When the rules of the game chance after the fact – insurers don’t necessarily see the federal government as a particularly reliable partner right now,” Levitt says. “This is one of several steps the Trump administration has taken to undermine the ACA.”… July 10, 2018: Slate posted an article titled: “Trump’s Office of Refugee Resettlement Is Budgeting for a Surge in Child Separations”. It was written by Mark Joseph Stern. From the article: …There are currently about 11,800 children in ORR’s (Office of Refugee Resettlement) care. Alex Azar, the secretary of the Department of Health and Human Services, has started that somewhere between 2,000 and 3,000 of those children were separated from their parents at the border. The remaining children in ORR custody are unaccompanied minors – children who crossed the border without a parent or guardian.In the documents obtained by Slate, ORR officials describe the budget implications of a potential surge in immigrant minors over the next three months. The ORR’s budgeting exercise is premised on the possibility that the agency could need as many as 25,400 beds for immigrant minors by the end of the calendar year. The documents do not indicate that ORR officials have specific knowledge that family separations will increase but do show that the agency is preparing for the possibility.The internal documents estimate that if 25,400 beds are needed, ORR would face a budget shortfall of $585 million for ORR for fiscal year 2018, which ends on Sept. 30. Under this scenario, that shortfall would increase to $1.3 billion in the first quarter of fiscal year 2019, adding up to a total shortfall of $1.9 billion for the period between Oct. 1, 2017, and Dec. 31, 2018. The documents stress that these budget estimates represent maximum possible expenditures and that actual expenses may be lower. The Department of Health and Human Services did not respond to multiple requests for comment about these figures or anything else relating to the documents,To help cover potential costs, the documents say, HHS will seek supplemental appropriations from Congress. The documents also indicate that HHS plans to pay for child separation by reallocating money from the Ryan White HIV/AIDS Program, which, according to its website “provides a comprehensive system of care that includes primary medical care and essential support services for people living with HIV who are uninsured or underinsured.” Per the documents, the process of transferring those HIV/AIDS funds has already begun… July 12, 2018: The New York Times posted an article titled “Fact Check of the Day: Democrats Overstate Kavanaugh’s Writings on the Affordable Care Act”. It was written by Linda Qiu. The article starts with quotes from three Democratic Senators, and states that their comments are exaggerated. This is followed by a fact check. The reason this is noteworthy is because Justice Anthony Kennedy retired from the Supreme Court of the United States – giving President Trump a second opportunity to nominate someone to fill that seat. Trump selected Judge Brett M. Kavanaugh, who would have to go through at least one hearing, and a favorable vote by the full Senate, before he can join the Supreme Court. …Judge Kavanaugh has written two dissenting opinions in the legal challenges to the Affordable Care Act while serving on the United States Court of Appeals for the District of Columbia Circuit.In both cases, he refrained from making broad pronouncements about the constitutionality of the Affordable Care Act, said Wendy Parmet, a professor of health law at Northeastern University.She characterized one dissent as “very boring, technical, very arcane” and the other as “very technical, lawyerly, and boring.”Nicholas Bagley, a professor of health law and administrative law at the University of Michigan disagreed with the Democrats’ framing of Judge Kavanaugh’s writings. He said Judge Kavanaugh “doesn’t think of these cases as Affordable Care Act cases” but instead focuses on specific legal issues… The article then looks at three Affordable Care Act related cases in which Judge Kavanaugh was involved. …Seven-Sky v. Holder: In 2011, Judge Kavanaugh’s appeals court upheld the Affordable Care Act’s individual mandate that compelled most Americans who do not have health insurance to pay a penalty. (The tax law signed by President Trump in December repealed the mandate, effective 2019.)In his dissent, Judge Kavanaugh argued that the court should not have heard the case in the fist place, since the Anti-Injunction Act of 1867 forbids judges to rule on tax cases until the tax has already been collected. The individual health care mandate did not take effect until 2014 so, he wrote, plaintiffs sued prematurely and “the Anti-Injunction Act precludes us from deciding this case at this time.”……”I do not take a position here on whether the statute as currently written is justifiable under the Taxing Clause or the Commerce Clause,” Judge Kavanaugh wrote. “What I am saying is that the only potential Taxing Clause shortcoming in the current individual mandate provision appears to be relatively slight.”……Sissel v. Department of Health and Human Services: In 2015, taxpayers challenged the Affordable Care Act on grounds that it violated the Constitution because revenue-raising bills must originate from the House of Representatives under the Origination Clause.This appeals court rejected the challenge, ruling that the clause did not apply because the law’s primary purpose was to expand health care, not to raise revenue. Judge Kavanaugh again wrote the dissenting opinion which argued that although the health law is a revenue-raising bill, it “did in fact originate in the House, as required by the clause.”… July 12, 2018: The Hill posted an article titled: “Trump health chief defense suspending ObamaCare payments.” It was written by Nathaniel Weixel. From the article: The Trump administration is bound by a federal court decision to suspend billions of dollars in ObamaCare payments, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said Thursday……In a surprise announcement last week, the administration said it had suspended $10.4 billion in “risk adjustment” funding that is supposed to be paid to insurers to help them provide coverage to particularly sick and costly enrollees……A federal court ruling in New Mexico found the administration did not properly justify its formula for dispensing the funds. Varma said the administration is defending the risk adjustment regulation, even though it was written under the Obama administration.Verma said CMS is asking the court to reconsider, but until that happens, the agency’s hands are tied……Legal experts have expressed skepticism that the administration is doing everything it can to fix the problem.Some have said CMS is being deliberately disruptive because of its hostility to ObamaCare, and that government programs should not be at the mercy of a lone federal judge.But at the same time, Verma would not say if the administration plans to stop approving state Medicaid work requirement waivers… July 12, 2018: The Hill posted an article titled: “House panel advances bill that would temporarily halt ObamaCare’s employer mandate”. It was written by Jessie Hellmann. From the article: The House Ways and Means Committee on Thursday approved legislation that would chip away at ObamaCare, including a measure that would temporarily repeal the law’s employer mandate.The bill sponsored by GOP Reps. Devin Nunes (Calif.) and Mike Kelly (R- Pa.) would suspend penalties for the employer mandate for 2015 through 2019 and delay implementation of the tax on high-cost employer-sponsored health plans for another year, pushing it back to 2022.Congress repealed the penalty associated with the individual mandate last year, but it doesn’t take effect until 2019……Powerful lobbying groups like the U.S. Chamber of Commerce have pushed for a repeal of the employer mandate.The other measure, sponsored by Reps. Peter Roskam (R.-Ill.) and Michael Burgess (R-Texas), would allow the use of ObamaCare’s tax credits for plans outside of the exchanges in the individual market. It would also allow anyone to purchase a catastrophic plan – plans that are cheaper but cover fewer services and are currently only available for those under the age of 30….…Both measures advanced on party-line votes.Democrats opposed the bills, saying they would cost too much and destabilize ObamaCare. July 13, 2018: Vox posted an article titled: “How the slow sabotage of Obamacare may hurt America’s breast-feeding rate”. It was written by Julia Belluz. …the Affordable Care Act (ACA), also known as Obamacare, included provisions aimed at supporting mothers who want to breastfeed, as part of its expansion of preventative-health services coverage. The regulations – and how they are applies by companies – haven’t been perfect, and some women have fallen through the cracks.But in recent years, several studies have shown that the provisions – giving moms access to lactation consultants, breast pumps, and time and space at work to pump their milk until as late as a year after birth – have contributed to rising breastfeeding rates in the US.The ACA’s regulations went into effect in 2010 and 2012. From 2011 to 2014, the rate of women who were breastfeeding 12 months after giving birth rose from 27 percent to 34 percent, according to the Centers for Disease Control and Prevention. That amounted to the largest increase in any recent three-year period.Now, women’s health and breastfeeding advocates worry that we might be poised for a reversal of this trend.The news that the administration of President Donald Trump undermined breastfeeding at a United Nations global health meeting and aligned itself with the $70 billion baby formula industry has sent a powerful signal that expanding breastfeeding access won’t be a priority for his administration……In addition, the administration’s focus on sabotaging the ACA doesn’t bode well for breastfeeding rates. It means that fewer people will access health care and insurance companies can now sell skimpier, short-term plans with few benefits and protections (such as coverage for preventative services like breastfeeding support.)……Section 2713 of the law [the ACA] requires health insurance plans to provide coverage for breastfeeding support (like lactation counseling) and supplies (such as breast pumps) without any co-payments, deductibles, or co-insurance, as long as a woman opts for breastfeeding. This coverage is required for employer-sponsored plans, individual plans purchased through the Obamacare marketplaces, and for Medicaid enrollees who access public coverage through the ACA’s Medicaid expansion.Section 4207 of the ACA also requires that companies with annual sales of more than $500,000 provide break times and a private place (not including a bathroom) where moms can use breast pumps to express their milk at work……Mara Gandal-Powers, of the Women’s Health Law Center, explained that these stories [of women whose health insurance companies refused to cover lactation consulting] are not uncommon. Because lactation consulting is a service that women need immediately after birth, they’re not typically in a position to haggle with insurance companies over coverage. “If you don’t get the services to help you increase your [breast milk] supply quickly, nursing can become difficult or impossible and not really happen. So we see women who pay out of pocket.”Instead of working to fix these gaps in coverage, the Trump administration has been attempting to dismantle the ACA. And while Republicans have failed to fully repeal the law, they’ve put forward a series of policies that have caused the uninsured rate to rise and have weakened the law in the process……Breastfeeding is a “preventative service,” said Kaiser’s Salganicoff. “So if its a short-term plan, it doesn’t have to have maternity care, preventative services and women who enroll in the plans would not have the entitlement to the breastfeeding coverage.” July 13, 2018: Press of Atlantic City posted an article titled “N.J. extends 2019 Obamacare rates deadline amid federal shakeups”. It was written by Nicole Leonard. From the article: …State insurers are expected this month to determine how much residents who get health care coverage through the ACA should pay for their plans in 2019, but a recent disruption by President Donald Trump’s administration on payments that have helped stabilize the market is causing delays.The White House announced earlier this month that billions of dollars in federal payments under the ACA’s risk-adjustment program will be put on hold……The freeze on the payments comes at a crucial time when insurers try to calculate what they should charge customers next year. Nearly 275,000 New Jersey residents selected Obamacare plans on the federal exchange during last year’s enrollment period, according to the U.S. Centers for Medicare and Medicaid……In response to the federal announcement, New Jersey Department of Banking and Insurance officials said they extended the deadline for insurers to file ACA plan rates by another week to July 18 because the decision to halt adjustment payments came just days before the state’s original deadline of July 11……The state’s insurance department told New Jersey Obamacare insurers, which this year included Horizon BlueCross BlueShield of New Jersey, AmeriHealth and Oscar, in a July 9 memo that they should calculate their plan rates, or premium prices, assuming the risk-adjustment payments will resume……State officials said final ACA plan rates are expected to be finalized and released by the end of the summer ahead of open enrollment, which begins Nov. 1. July 13, 2018: Nashville Patch posted an article titled: “Tennessee Obamacare Insurers Cutting Premiums”. It was written by J. R. Lind. From the article: For the first time, Tennesseans with coverage through the health-insurance exchanges set up by the Affordable Care Act will see their premiums go down.According to state regulatory filings, Cigna plans to reduce premiums for its individual plans by an average of 4.8 percent and BlueCross BlueShield of Tennessee will slash its average rate by 10.9 percent.Both Cigna and BCBST increased premiums by double digits the last four years.Oscar, the only other company offering individual plans in Tennessee, requested a 10.8 percent premium increase… July 16, 2018: Pacific Standard posted an article titled: “After a Report Criticizing Obamacare Removals From Medicaid.Gov Starts to Circulate, The Law Gets A Boost on Medicaid’s History Page.” It was written by France Diep. From the article: After a government transparency group tried to alert the Centers for Medicare and Medicaid Services (CMS) of an upcoming report, – which showed that a bank of webpages about Obamacare had been pulled from Medicaid.gov – a fresh batch of Obamacare information appeared in a prominent place on the site. At the bottom of Medicaid.gov’s “Program History” page, there’s now a table breaking down the numerous ways that the Affordable Care Act has affected Medicaid, expanding the number of Americans who are eligible and improving its benefits.…But a spokesman for CMS said that the update is a coincidence……Pacific Standard noticed the update after reporting on work from the Sunlight Foundation’s Web Integrity Project, which uses software to track tens of thousands of .gov webpages. Web Integrity Project Director Toly Rinberg says a staffer sent out inquiries to CMS in the afternoon on July 9th, and on July 11th.The project’s software shows the “Program History” page did not contain the Affordable Care Act table on the morning of July 9th; Google’s caching shows that, by the early morning hours of July 10th, it did. The table contains all the sections that had previously appeared on an Affordable Care Act landing page that was removed from Medicaid.gov in June. July 19, 2018: WLKY posted an article titled: “Reversal: Kentucky restoring Medicaid benefits for thousands.” From the article: Kentucky Gov. Bevin’s administration says it’s reinstating dental and vision care for hundreds of thousands of Medicaid recipients who had their benefits cut recently amid an outcry.The benefits were abruptly cut after a federal judge rejected the Republican governor’s plan to overhaul Kentucky’s Medicaid program. The cuts triggered stinging criticism from Democrats and public health advocates.The reversal was announced late Thursday by the state’s Cabinet for Health and Family Services. It says dental and vision coverage are being restored to “mitigate the consequences” of the ruling.The ruling marked a setback for President Donald Trump’s administration, which has been encouraging states to impose work requirements and other changes on the state and federal health insurance program for poor and disabled people.The ruling blocks those requirements for now in Kentucky. July 19, 2018: The New York Times posted an 0pinion piece titled: “Want Reliable Medical Information? The Trump Administration Doesn’t”. It was written by The Editorial Board of The New York Times. From the Opinion piece: …On Monday, the Department of Health and Human Services took it [The National Guideline Clearinghouse] offline, the latest casualty in an administration determined to eliminate science from the government’s agenda.The official explanation is maddening enough: a budget shortfall that roughly equals the amount Tom Price spent on travel during his brief tenure as department secretary. The site costs just $1.2 million a year to operate, and is maintained by an agency with a budget of more than $300 million.But the more complete explanation – involving political discord over the site’s parent agency and sustained indifference on the part of the doctors and patents – should concern anyone worried about the state of American health care.The clearinghouse was created in the 1990s as part of a wider movement to better link the practice of medicine to sound scientific research. It has been in danger of disappearing almost since the start.Republicans argue that the database is redundant with other programs. But in some cases, other motivations for eliminating it have been all too clear. In the late 1990s, when it endorsed nonsurgical interventions for back pain, the back surgeon lobby waged an attack that resulted in huge funding cuts and placed a permanent target on the Agency for Healthcare Research and Quality (A.H.R.Q.), the agency that houses the database.Since then, A.H.R.Q. has survived numerous attempts on its life, most recently in 2017, when the Trump administration proposed folding it into the National Institutes of Health. To its credit, Congress rejected that proposal, and instead gave the agency a $10 million bump. But the increase was not enough to undo the damage done by all the previous years’ cuts. Adjusted for inflation, A.H.R.Q. has lost about $120 million in funding since 2010……Budget cuts are not the only problem, though. The clearinghouse gets about 200,000 visitors a month, and professional medical societies have protested the database’s closing. But many individual doctors have greeted the news with a shrug, saying they only rarely visit the site anyway. And most consumers have no idea what the database is, or why it matters.That’s too bad. America spends around $3.5 trillion a year on health care, and more than $30 billion on biom